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?*

 Yes 

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
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