Radiology Clerkship Pre-Approval Application Form International Visiting Medical Student

Radiology Clerkship Pre-Approval Application Form

International Visiting Medical Student

Please complete the application form and send a copy of your CV and professional headshot for a pre-approval.

*Incomplete form will not be reviewed

Applicant Information

Last Name*

First Name*

Email Address*

Education

Undergraduate School and Degree*

Medical School*

Grades on Core Clerkships

(Write "N/A" if rotation not yet completed)

a. Internal Medicine:*

b. Pediatrics:*

c. Surgery:*

d. OB/GYN:*

e. Psychiatry:*

f. Family Medicine:*

g. Neurology: *

USMLE Step 1 Score (3-digit score or Pass/Fail):*

(Write "N/A" if USMLE Step 1 not yet been completed)

TOEFL/IELTS/OET Score:*

(Select "N/A" if this does not apply)

Select

TOEFL Score*

IELTS Score*

OET Score*

Personal Statement*

In 180 words or less, please explain why you seek a rotation in Radiology at Stanford.

Clerkship

Please indicate which clerkship you are interested in.

Select Clerkship*

Select

Clerkship Periods

List your choices in order of preference. For period dates, please visit the following link:

Clerkship Period Dates

First Choice*

Select

First Choice*

Select

Second Choice*

Select

Second Choice*

Select

Third Choice*

Select

Third Choice*

Select

Clerkship Duration*

Are you interested in a 2-week or a 4-week rotation?

Select

Stanford Residency

Will you be applying to the following Stanford Residency Programs?

Diagnostic Radiology (DR)*

Select

Interventional Radiology (IR)*

Select

Nuclear Medicine/Diagnostic Radiology (NM/DR)*

Select

CV and Professional Headshot

Curriculum Vitae (CV)*

Please upload a copy of your current CV.

(File Name: LastName, FirstName_CV)

Upload Here

Professional Headshot*

Please upload a copy of your current headshot.

(File Name: LastName, FirstName_Headshot)

Upload Here

Send me a copy of my responses

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