Default Page School of Medicine Students /Resident Application Name Address City State Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Maryland Massachusetts Michigan Minnesota Mississippi Missouri Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Phone Number Email Address School Name School Address School City School State Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Maryland Massachusetts Michigan Minnesota Mississippi Missouri Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming School Zip Program Director Program Director's Phone Number Program Director's Email Address Department and/or Physician Requested Type of placement you are interested in Observership: Is a structured and supervised clinical rotation without direct patient contact. An observer will be able to observe the healthcare staff in the clinical setting. You will be always accompanied by an attending physician or healthcare staff when observing patients. Residency Rotation: Is a hands-on clinical experience including patient-focused clinical exposure for those that have completed medical school and received a degree. This may include recording patient histories, examining patients, presenting cases, and giving differential diagnoses to the supervising physician. Residents are given directives by the supervising physician. Select a type of placement Select One Observership Residency Rotation Other Other type of placement? Write a brief description of what you hope to achieve during your time at Christie Clinic Availability Expected Start Date Expected End Date Expected Frequency including days of the week and hours Chronological summary of educational experience
