Emergency Medicine Medical Student Clerkship Application

Need more information? Call: 717-231-8722

Personal Info

First Name Last Name Email Address Phone Number Street Address 1 Street Address 2 City State Zip Code Medical School MS3 MS4

Requested Rotation date(s) to start a 4 week block

1st Choice 2nd Choice 3rd Choice

Board Exam/AOA/SSP (Optional)

USMLE Step 1 USMLE Step 2 CK USMLE Step 2 CS COMLEX Step 1 COMLEX Step 2

Miscellaneous

Alpha Omega Alpha/Sigma Sigma Phi Member Was your medical education/training extended or interrupted? Yes No EMIG Officer/Involvement? In ONE paragraph explain why you are interested in Emergency Medicine: In ONE paragraph, explain why you are interested in rotating at UPMC in Central Pa:

I understand that by providing my email address, I agree to receive emails from UPMC. I understand that I may opt out of receiving such communications at any time.

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Contact UPMC in Central Pa.