Baton Rouge General Medical Student Elective Rotation Application

Baton Rouge General Medical Student Elective Rotation Application

Last Name*

First Name*

Email Address*

Phone*

Address*

City*

State*

Zip Code*

Citizenship*

Race/Ethnicity*

School Currently Enrolled*

Specific Rotation Requested- First Choice*

Specific Rotation Requested- Second Choice*

Rotation Start Date*

Rotation End Date*

Undergraduate and Graduate Education*

Current Year of Medical School*

3rd Year Medical Student

4th Year Medical Student

Expected Graduation Date*

Tell us a bit about yourself (e.g. where you are from, background, interests, future plans, etc.).*

Why are you interested in this specialty?*

Why would you like to rotate in Baton Rouge, Louisiana?*

File Upload*

USMLE/COMLEX scores COVID-19 Vaccination Documentation

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