2021 BIDMC Virtual Neurosurgery Clerkship Registration Form

1. Registration

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* 1. Which Virtual Internship will you be attending?

July enrollment closed

August 9 - 13 from 3pm to 6 pm EST

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* 2. What is your last name?

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* 3. What is your first name?

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* 4. What are your preferred pronouns?

he/his

she/her

they/their

ze/zir

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* 5. What in the best email addresses to send you information about this event ?

Address 1

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* 6. What is the name of the medical school you are attending ?

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* 7. Location of Medical School:

International

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* 8. Please provide the city and state of your medical school.

City

State

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* 9. What year medical student are you?

MS 1

MS 2

MS 3

MS 4

Post Graduate

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* 10. Are you panning to applying for Neurosurgery residency next year (2022) ?

Yes

2021 BIDMC Virtual Neurosurgery Clerkship Registration Form

1. Registration

Question Title

* 1. Which Virtual Internship will you be attending?

Question Title

* 2. What is your last name?

Question Title

* 3. What is your first name?

Question Title

* 4. What are your preferred pronouns?

Question Title

* 5. What in the best email addresses to send you information about this event ?

Question Title

* 6. What is the name of the medical school you are attending ?

Question Title

* 7. Location of Medical School:

Question Title

* 8. Please provide the city and state of your medical school.

Question Title

* 9. What year medical student are you?

Question Title

* 10. Are you panning to applying for Neurosurgery residency next year (2022) ?

Question Title

* 11. Please provide a rational why you are applying for this Virtual Sub-I at BIDMC. (100 word max)