If more than one elective is requested, please use a separate form for each elective. For each elective requested, you must request alternative dates. Electives must be requested at least 60 days prior to the start date.
Clinical electives are on a space available basis.
Please understand that your application will not be reviewed until all forms and required information is received. WILL or WILL NOT be covered by Malpractice Insurance during the clerkship. WILL or WILL NOT be covered by Personal or Student Health Insurance during the clerkship. WILL or WILL NOT be taking this elective for credit. WILL or WILL NOT have an evaluation form to be completed from our institution.