Application for US Clinical Rotation
(Fill out separate forms for each rotation)
Name
*
First Name
Last Name
Phone/WhatsApp
*
-
Country Code (+)
Phone Number
Email
*
example@example.com
Medical School Name & Address
*
Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Clinical Rotation Site: Hospital Name (Copy & Paste from "Availability" Table)
*
Clinical Experience Type (Copy & Paste from "Availability" Table)
*
Month Preference (Write one specific month after discussing availability with IFMGE Team)
*
Checklist
*
IFMGE USCE payment receipt (Sent to your email or available to download from your IFMGE account "Click your name -> Orders")
Valid passport (immediate submission) or USA Visa (both must be submitted 1 month prior rotation)
Proof of medical school enrollment/degree certificate/transcript
USMLE exam score report (if any)
Recent photo
Valid health insurance (optional)
HIPAA certificate
Recent immunization records either vaccination titers or vaccination history signed by physician (with proof of COVID-19 vaccines and Influenza shot)
COVID-19 RTPCR test results at least 72 hours prior to the start date or date of arrival (Optional)
Upload Documents With Clear File Name
*
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Application -
$
700.00
Application + Advance Booking + Publication APC + LoR Drafting Fee
Baylor St. Luke’s Medical Center, Houston, TX - Internal Medicine (Externship) -
$
1,500.00
CHI St. Luke’s Health and Kindred Hospital, Houston, TX - Neurology and Sleep Medicine (Externship/Elective) -
$
1,500.00
Crestwood Medical Center, Huntsville, AL - Pulmonary Critical Care & Sleep Medicine (Externship/Elective) -
$
1,500.00
Crestwood Medical Center, Huntsville, AL - Radiology - Interventional Pulmonology + Chest Imaging (Externship/Elective) -
$
1,500.00
Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Health, Mount Kisco, NY - Anatomical & Surgical Pathology (Tele-rotation) (2 months)
$
1,500.00
HCA Houston Healthcare Northwest, Houston, TX - Cardiology (Clinical + Interventional) (Externship/Elective) -
$
1,500.00
HMH JFK University Medical Center, Edison, NJ - Emergency Medicine + Internal Medicine (Externship/Elective) -
$
1,500.00
HMH JFK University Medical Center, Edison, NJ - Emergency Medicine (Externship/Elective) -
$
1,500.00
HMH JFK University Medical Center, Edison, NJ - Internal Medicine & Infectious Disease (Externship/Elective) -
$
1,500.00
Houston Methodist & HCA Houston Healthcare Medical Center, Houston, TX - Cardiology (Clinical + Interventional) (Externship/Elective) -
$
1,500.00
Houston Methodist Hospital, Houston, TX - Hematology & Oncology (Externship/Elective) -
$
1,500.00
Interfaith Medical Center and New York University Langone Health, Brooklyn, NY - Cardiology (Clinical + Interventional) (Externship/Elective) -
$
1,500.00
Interfaith Medical Center and New York University Langone Health, Brooklyn, NY - Radiology - Interventional Cardiology and Cardiac Imaging (Externship/Elective) -
$
1,500.00
Jackson Park Hospital, Chicago, IL - Family Medicine (Externship) -
$
1,500.00
Keystone Health Center and WellSpan Chambersburg Hospital, Chambersburg, PA - Infectious Disease (Externship/Elective) -
$
2,000.00
Manhattan Wellness Psychiatry, New York, NY - Psychiatry (Externship) (2 months) -
$
1,500.00
Medical University of South Carolina (MUSC) Downtown Center, Columbia, SC - Neurology, Stroke, and Child Neurology (Externship/Elective) -
$
1,500.00
MedStar Health, Baltimore, MD - Internal Medicine (Externship) (2 months) -
$
3,000.00
Montefiore St Lukes Cornwall Hospital And Horizon Family Medical Group, New Windsor, NY - Gastroenterology & Internal Medicine (Externship/Elective) -
$
1,650.00
Montefiore St Lukes Cornwall Hospital And Horizon Family Medical Group, New Windsor, NY - Cardiology & Internal Medicine (Externship/Elective) -
$
1,650.00
Penn State Hershey Medical Center and Pennsylvania Psychiatry Institute - Child and Adolescent Psychiatry (Externship/Elective) -
$
1,500.00
Quannet Health - Psychiatry (Externship) (2 months) -
$
1,500.00
Insight Hospital & Medical Center Chicago - Hematology & Oncology (Externship/Elective) -
$
1,500.00
Prime Healthcare, NJ - Internal Medicine (Externship) -
$
2,500.00
Prime Healthcare, NJ - Internal Medicine Audition Rotation - Internal Medicine (Externship) (3 months) -
$
10,000.00
South Shore Hospital, Chicago, IL - Neurology (Externship/Elective) -
$
1,500.00
Sunrise Children’s Hospital and Children's Hospital of Nevada at University Medical Center, Las Vegas, NV - Neurology, Epilepsy, and Child Neurology (Externship/Elective) -
$
1,500.00
Sunrise Children’s Hospital and Children's Hospital of Nevada at University Medical Center, Las Vegas, NV - Child Neurology (Externship/Elective)
$
1,500.00
University of Texas MD Anderson Cancer Center, Houston, TX - Hematology & Oncology (Tele-rotation) -
$
1,500.00
University of Texas MD Anderson Cancer Center, Houston, TX - Hematology & Oncology (Externship/Elective) -
$
1,500.00
IMG Bootcamp Program, NJ -
$
1,000.00
Internal Medicine, Family Medicine, and Emergency Medicine
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Subtotal
$
0.00
Tax
$
0.00
Total
$
0.00
Credit Card
Note to get attention/ specified rotation month if its not starting in the 1st of the month
I have discussed the details of this rotation with IFMGE Team. I have paid the application fees and clinical rotation fees. (Non-refundable)
*
Yes
Signature
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