Medical Student Research Inquiry

Medical students from affiliate schools who will rotate or have rotated at Western Reserve Hospital may participate in research with our faculty and residents. Please fill out this form to let us know of your interest in research and/or inform us of a project you are working on already. If you are not currently part of a project, we will try to match you with projects throughout the hospital.

Form Date Field*

First Name*

Last Name*

Email Address*

Medical School*

Select or enter value

Medical School name, if other:*

I am interested in participating in research.

I am already working on research at WRH.

Name of resident or attending you are working with

If you are working on more than one project, please list one resident or attending for each project, and label (1) (2), etc.

Name of research project

If you are working on more than one project, please list all. Label (1) or (2) as needed to coincide with above resident/attending.

Residency area of interest*

Select the residency specialty you are pursuing.

Select

Subspecialty area of interest

If you plan to pursue a subspecialty after residency, please list here.

Research area(s) of interest*

Please list area(s) of interest in order of most desired.

Scholarly Activity Experience*

Which scholarly or research activities do you have experience with?

Select or enter value

Specify "other"

Send me a copy of my responses

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