GME Application

 

Choose all that apply.

 
 
 
 
 
 
 
 
 
mm/dd/yyyy
 
 

 

Basic Information

 
 
 
 
 

 

Addresses

 

Current Mailing Address

 
 
 
 
 
 
 
 

 

Work Authorization

 
 

Eligibility for ECFMG J-1 visa sponsorship is not to be presumed. For details on ECFMG J-1 requirements and restrictions, please visit http://www.ecfmg.org/evsp/requirements.html

 
 

 

Additional Information

 
 

(Required for D.O. applicants)

 
 
 
 
 

 

Biographic Information

 

Self-Identification

This section allows you to indicate how you self-identify. When selecting “Other” as a subcategory, the text field is limited to 120 characters; however, it is not a required field. If you prefer not to self-identify or if you reside in the European Union, please ignore this section.

 

Please select all that apply.

 

Language Fluency

What languages do you speak? Select all that apply. For each language that you select, including English, you will be asked to rate your proficiency in that language using the guidelines provided below.*


Native/Functionally Native: I converse easily and accurately in all types of situations. Native speakers, including the highly educated, may think that I am a

native speaker, too.


Advanced: I speak very accurately, and I understand other speakers very accurately. Native speakers have no problem understanding me, but they probably

perceive that I am not a native speaker.


Good: I speak well enough to participate in most conversations. Native speakers notice some errors in my speech or my understanding, but my errors rarely

cause misunderstanding. I have some difficulty communicating necessary health care concepts.


Fair: I speak and understand well enough to have extended conversations about current events, work, family, or personal life.

Native speakers notice many errors in my speech or my understanding. I have difficulty communicating about health care concepts.


Basic: I speak the language imperfectly and only to a limited degree and in limited situations. I have difficulty in or understanding extended conversations. I am unable to understand or communicate most health care concepts.

 
 
 
 

Military Information

 
 
 

Additional Information

 

510 Characters Max

 
 

50 Characters Max

 
 

 

Education

 

Higher Education

This section allows multiple entries for each undergraduate and graduate school you have attached.

 
 

Higher Education Entry 1

 
 
 
 
 
 

Additional Information

 

255 Characters Max

 
 

510 Characters Max

 
 

510 Characters Max

 
 

 

Experience

 

Training

Please add an entry for each of your current or prior trainings. If necessary, please work with your supervisor to determine an end date for a training you are currently completing.


If your program was accredited by the American Osteopathic Association (AOA) when you completed your training, please select the option with "AOA" noted in the Type of Training and Specialty menus.

 
 

Training Entry 1

 
 
 
 
 
 
 
 
 
 
 
 
 

510 Characters Max

 
 

Training Entry 2

 
 
 
 
 
 
 
 
 
 
 
 
 

510 Characters Max

 
 

Experience

Please add any additional experience. Clinical and teaching experience should be treated as work experience. Include all unpaid extracurricular activities and committees on which you have served as Volunteer Experience.

 
 

Experience Entry 1

 
 
 
 
 
 
 
 
 

1020 Characters Max

 
 

510 Characters Max

 
 
 
 
 
 

Experience Entry 2

 
 
 
 
 
 
 
 
 

1020 Characters Max

 
 

510 Characters Max

 
 
 
 
 
 

Additional Information

 
 

 

Licensure

Please add an entry for any of your state medical licenses.

 
 

Licensure Entry 1

 
 
 
 
 
 

Licensure Entry 2

 
 
 
 
 
 

Additional Information

 
 
 

(Note: This section is not intended to solicit information about your health, disability, or family status.)

 
 
 
 
 
 
 

 

Publications

Add an entry for each of your publications.

 

Peer-Reviewed Journal Articles/Abstracts

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
 
 

(e.g., 200-212)

 
 
mm/dd/yyyy
 

Peer-Reviewed Journal Articles/Abstracts (Other than Published)

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
 
mm/dd/yyyy
 

Peer-Reviewed Book Chapter

 

255 Characters Max

 
 
 

(Last Name, First Initial, Middle Initial)

 
 

(First Initial, Middle Initial, Last Name)

 
 
 

(e.g., 200-212)

 
 
 
 
 

Scientific Monograph

 

255 Characters Max

 
 
 
 
 

(Last Name, First Initial, Middle Initial)

 
 
 

Other Articles

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
mm/dd/yyyy
 

Poster Presentation

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
 
 
 
 

Oral Presentation

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
 
 
 
 

Peer-Reviewed Online Publication

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
mm/dd/yyyy
 

Non-Peer-Reviewed Online Publication

 

255 Characters Max

 
 

(Last Name, First Initial, Middle Initial)

 
 
 
 
mm/dd/yyyy
 

 

Certification

 

I certify that the information contained within this application is complete and accurate to the best of my knowledge. I understand that any false or missing information may disqualify me from consideration for a position; or if employed, may constitute cause for termination from the program.


In addition, I consent to the transfer of my personal data to DHR Health and the GME programs that I select through my application.

 

Upload the following files where applicable:


-    3 Letters of Recommendation (1 from Chair or Program Director – if applicable)

-    ACLS card

-    ATLS card

-    BLS card

-    CV

-    Dean’s Letter – Medical Student Performance Evaluation (MSPE)

-    ECFMG certificate (if applicable)

-    ERAS application (if available)

-    PALS card

-    Personal Statement

-    Photo

-    Transcript – medical school

-    USMLE / COMLEX Transcript

Drop your files here