VCMC Medical Student Externship Application
Personal Information
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First Name
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Last Name
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Email Address
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Address
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City
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State/Province
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Zip/Postal Code
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Phone Number
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Medical School
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What is your date of (anticipated) med school graduation?
Medical School Performance
USMLE Step 1 Score
COMLEX Part 1 Score
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Have you ever failed or need to remediate a medical school course? If so, please explain below.
Yes
No
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Have you ever failed the USMLE Step 1 or COMLEX Part 1? If so, please explain below.
Yes
No
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Have you ever taken a leave of absence from medical school? If so, please explain below.
Yes
No
Rotation Preferences
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Year of Medical School during requested rotation
4th
3rd
Requested Dates for Externship
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1st choice - Start Date:
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End Date:
2nd choice - Start Date:
End Date:
Please rank your preference for which rotation you would like to do (1-most, 7-least)
Inpatient Medicine Pediatrics
Outpatient Pediatrics
Obstetrics and Gynecology
Intensive Care Unit
Surgery
Emergency Room (except July/August)
Orthopedics/Sports Medicine
Additional Information
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Are you planning to match in Family Medicine?
Yes
No
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Are you planning to apply to our program?
Yes
No
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Please include a brief personal statement, including your interest in Family Medicine.
Do you have any questions you would like us to address when we contact you?
Do you need help finding a place to stay during your externship?
Yes
No
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