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 (exact beggining and end date if its not the begging of the month) after discussing availability with IFMGE Team)
*
Checklist
*
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
Visa Letter Support
$
150.00
Only provided after application fee has been paid so student must had paid a total of $700 + $150 =$850
Audition Rotation, NJ - Internal Medicine (Externship) (1 months) -
$
2,500.00
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
EEG, EMG, and Neuroimaging Bootcamp Program, Las Vegas, NV - Adult and Child Neurology (Tele-education) -
$
1,000.00
HCA Houston Healthcare Northwest, Houston, TX - Cardiology (Clinical + Interventional) (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
Insight Hospital & Medical Center Chicago, Chicago, IL - 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
Internship Bootcamp Program, NJ - Internal Medicine & Family Medicine -
$
1,000.00
Jackson Park Hospital, Chicago, IL - Family Medicine (Externship) -
$
1,500.00
Manhattan Wellness Psychiatry, New York, NY - Psychiatry (Externship) -
$
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) -
$
1,500.00
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
Quannet Health, White Plains, NY - Psychiatry (Externship) -
$
1,500.00
Radiology Bootcamp Program, NJ - Radiology (Tele-education) -
$
1,000.00
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
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Apply
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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