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McLaren Health Care - Hospitals in Michigan
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Laren Health Care
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McLaren Greater Lansing Pre-Application for Elective Rotation Request
Instructions: This is a secure site. Please complete the information below.
*Indicates required information
Your Contact Information
Name (Last, First, Middle Initial)
Address Line 1: *
Address Line 2:
City: *
State: *
Zip Code *
Email Address *
Phone *
Rotation Information
Elective Rotation Requested *
Anesthesiology
FamilyMedicine
GeneralSurgery
InternalMedicine
OB/GYN
OrthopedicSurgery
Requested Elective Dates
From *
To *
Second Choice
From
To
Board Scores
COMLEX 1
Pass
Fail
COMLEX 2
Pass
Fail
If not taken, what date is COMLEX 2 scheduled?
USMLE 1
Pass
Fail
USMLE 2
Pass
Fail
If not taken, what date is USMLE 2 scheduled?
Medical School
Institution and Location *
Have you ever failed a medical school course? *
Yes
No
If so, please explain the circumstances
Why do you want to come to MGL for an Elective Rotation in this Residency?
Undergraduate
Institution and Location *
Field of Study *
Degree *
Graduate
Institution and Location *
Field of Study *
Degree *
Do you think that your scores or grades are are a good indication of your academic achievement? *
Please assess yourself as compared to other medical students. *
What does teamwork mean to you? *
Medical School Awards and Honors
Research Experience
Publications
Community and Volunteer Activities
What are your career goals? *
What three qualities do you believe a successful physician (in this specialty) should possess? Please describe your attributes in these areas *
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