In order to process your application, the review committee will need the following documents emailed to beth.kautz@aultman.com.
1. CV
2. Photo
3. USMLE Step 1 (2 if available) or COMLEX Level 1 (2 if available) first time pass score.

If documents are not received within 30 days of the application date, application will be discarded.
If approved, the department of Medical Education must receive the following prior to your start date:
1. Letter stating you are a medical student in good standing who has been approved for this elective
2. Proof of malpractice coverage by your medical school
3. Health record
4. Background check

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* 1. Name

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* 2. Address

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* 4. Phone

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* 5. Preferred Name

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* 6. Date of Birth

Date

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* 7. Gender

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* 8. Citizenship

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* 9. 1st choice of dates for elective (4 weeks)

Date
Date

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* 10. 2nd choice of dates for elective (4 weeks)

Date
Date

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* 11. Medical School Information

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* 12. Do you have transportation available?

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* 13. Do you have a connection to the Canton area?

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* 14. What is your interest in women's health?

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* 15. List the 3 most important goals you have for this elective:

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* 16. Hobbies/Non-Professional interests:

By typing my name below, I, the undersigned, agree to abide by the rules and regulations of Aultman Health System and their applicable policies and procedures while rotating at Aultman Hospital. I hereby certify that the above information is correct.

I understand I will be working hours similar to a PGY-1 resident in accordance with ACGME Section 6 The Learning and Working Environment for a total of 4 weeks. I will request time off prior to the start of my elective.

I am in my 4th year of medical school or will be by the first day of my elective at Aultman Hospital and in good standing.

To be eligible for an interview offer for residency, individuals must meet all requirements listed below:
• A first-time pass on USMLE Step 1 or COMLEX Level 1 and a first-time pass on USMLE Step 2 with a minimum score of 220 or COMLEX Level 2 with a minimum score of 500. If you have taken both USMLE and COMLEX, you must meet the requirements for both.
• ECFMG certification is not required when applying.
• Core clinical clerkship experience in the United States.
• May apply up to 2 years from medical school graduation, having been engaged in medical education through research or another academic experience during the gap.
• Instructional policy prohibits hiring new employees who smoke or use nicotine products.

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