Application & Information Form
Application & Confidentiality Contract is required prior to start date of the student’s rotation.
Letter of Good Standing & Proof of Malpractice Insurance
Please have your school or Hospital forward a letter of good financial & academic standing and approval of the clerkship or Externship for credit.
**[Malpractice Insurance can also be individually purchased from our office.]
Criminal Background Check
Medical institutions require a Criminal Background check to be in place Prior to the start of any clinical Rotation.
An overview of the student’s qualifications, education and clinical experience.
Proof of health insurance must be provided before the student can start their clerkship.
Canadian students can submit a copy of their health card. Please provide copies of front and back of document/card. Health Insurance can also be individually purchased or purchased from our office by contacting Dena Bessumi.
Student Health Clearance Certificate
Record of all updated immunizations at least 1 year from start date including MMR vaccination or immunity status, past Varicella infection or Varivax, Hepatitis B vaccination or refusal form, proof of Flu Shot, TB test (or if a known positive reactor, a negative chest xray). Records should be within 1 year of start date. Please include titer level reports.
Passport Size Photo
Please include 2 Passport size photo for identity verification purposes.
9 Panel Drug Test
Some specialties or Hospitals require undergoing a 9 Panel Drug Test.
Please provide copies of State/Provincial issued ID (Drivers License)
Please provide copies of main Page.
Proof of visa/immigration status in USA
Non-US Citizen students please provide copies of their immigration visa, which they will receive at US Customs either at the Airport or Border.
Please provide copies of certification if you have already completed these courses. Online courses are not accepted. These courses are not included in the application fee, additional charges apply.
All students will be required to attend a mandatory orientation session prior to the commencing clinical clerkships.
All students must attend a mandatory Suture & Scrubbing Workshop prior to doing any surgery clinical clerkships. This workshop is not included in the application fee, additional
charges may apply.