International Rotations

Any BCM program requesting to have a resident or fellow rotate to international sites will need to fill out this questionnaire.

Practitioner Name

Resident/fellow first and last name.

Practitioner Type

PGY Level

BCM Training Program

Rotation Start Date

mm/dd/yyyy

Rotation End Date

mm/dd/yyyy

Activities During Rotation

Briefly describe what the resident/fellow will be doing during the rotation.

BCM Program Director and Program Coordinator

Include their email addresses.

Name of Person Submitting Request

Host Institution's Primary Contact/s

Include their names, email addresses, and phone numbers.

Rotation Site Hospital or Clinic Name

Rotation Site Country and City

Is the Trainee on a Visa?

Emergency Contact Information

Include name, relationship, and contact information.

Is this Rotation Clinical or Non-Clinical

If non-clinical (research-only, observership only), please fill this form out and send to Keyasha.Mills@bcm.edu

Send me a copy of my responses