Application Request

Short-Term Clinical Electives with
the University of Kansas Medical Center

*denotes required field

Name* (As it appears on your passport)


Exact Mailing Address *



E-mail Address*


University / Institution*


University / Institution Address*


Expected Date of Completion and Graduation (M.D.)*
(Include month and year)


Have you taken the TOEFL?*
(The TOEFL is a requirement even if your University teaches in English.)

If Yes, When?   

Are you a U.S. Citizen?*


Are you a U.S. Permanent Resident?*

  Yes    No

What is your country of citizenship?

When do you wish to attend?*
(Include month and year. Note: Clinical rotations are not offered in the months of May and June.)

How did you find out about our program?*


Please provide a brief personal statement using 200-300 words on why you are interested in pursuing clinical electives with the University of Kansas Medical Center.*

Questions / Comments:


Last modified: Nov 21, 2013