Flexible MD Application

Flexible MD Application

Please make sure to read all application requirements prior to completing. Requirements can be found at: https://www.med.umn.edu/md-students/student-experience/flexible-md-program/application-and-reports

Email Tommy Van Norman, Manager of Student Affairs (tvannorm@umn.edu), with any questions or concerns.

Your Information

Last Name*

First Name*

UMN Email*

Must use your umn.edu email

Student ID*

Current MS Year*

What year in school are you

Select

Current Anticipated Grad Year*

What year are you currently anticipated to graduate (without the Flex MD)

Select

Current Campus*

Select

Current Academic Year*

What is the academic year currently, not the AY you will begin your Flex experience, but the AY right now as you submit this

Select

Your Experience

Experience Type*

Select or enter value

If "Other" please explain

If you selected "Other" above, please enter a category name that best describes your experience

Is this a paid experience?*

Pay includes stipend, hourly wage or salary

Select

Pay Amount*

What is your payment for this experience?

Ex: $20,000 stipend, or $45,000 salary, or $15/hr

Experience Description*

Brief description of project and how it will support your progress toward your MD and future career path. Please try to keep response to 300 words or less

Meaningful Enhancement*

Please explain how this experience will provide a meaningful enhancement to your MD degree. How will it make you a better physician and/or add value to your future career ambitions

Learning Objectives*

Please list THREE (3) specific learning objectives and how you will be assessed on completion of these learning objectives. "By the end of this experience, I will have learned how to....."

Location of your experience*

University, and/or department, or city, or country, or company, etc... (ex University of Chicago Dept. of Surgery, or Vail Institute, Vail CO.)

Your Research Mentor

Mentors must have direct knowledge of the research you plan to participate in Mentors must be prepared and qualified to guide you, as needed, during the entire length of the research experience and help you achieve your stated goals

Research Mentor Name*

Last Name, First Name

Research Mentor Title, Institution, and Department*

If at a separate institution from the UMN, please indicate school or institution name along with department

Research Mentor Contact Information*

Email address

Research Mentor Statement and Approval*

Students participating in a RESEARCH experience are REQUIRED to attach a letter from their research preceptor or mentor acknowledging that they approve of you participating in this research experience and that they have reviewed your goals and are prepared to guide you and help you achieve those goals (Note: It is not a requirement that you reach these goals, just that you strive for them and your mentor / preceptor has ability to help you to do this) Please attach a letter of support/acknowledgment from your research mentor / preceptor

Drag and drop files here or

Your Acknowledgment

I understand the following eligibility criteria and requirements for this Flexible MD experience, including: I acknowledge I am required to sit with reps from financial aid, and academic advising PRIOR to my app being reviewed by the Flexible MD Committee (once your app is submitted you will receive instructions to set-up this meeting) I acknowledge I must have successfully completed all begun coursework and any outstanding required remediation prior to participation. I acknowledge that if participating in this experience after my second year of school and prior to beginning clinical rotations that I am required to sit for my Step 1 exam prior to beginning my experience or by the end of clinical academic period B. I acknowledge that if participating in this experience after my third year of school that I am required to sit for my Step 2CK exam prior to beginning my experience or by the end of clinical academic period B. I acknowledge that I am required to submit progress reports every three (3) months. I acknowledge that I am required to submit and comply with a plan for reentry into the normal medical school curriculum. I acknowledge that at the end of my experience I am required to submit a final report

Acknowledgement of requirements*

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