Application for US Clinical Rotation
Name
*
First Name
Last Name
Phone/WhatsApp
*
-
Country Code (+)
Phone Number
Email
*
example@example.com
Medical School or Hospital Name & Address
*
Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Setting Id Preference & Hospital Name
*
Month Preference
*
Checklist
*
IFMGE USCE payment receipt (Sent to your email or available to download from your IFMGE account "Click your name -> Orders")
Valid passport and USA Visa
Proof of medical school enrollment/degree certificate
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
Upload Documents With Clear File Name
*
Browse Files
Cancel
of
Note to get attention
I have discussed the details of this rotation with IFMGE Team. I have paid the application fees and clinical rotation fees in advance. (Non-refundable)
*
Yes
Payment Billing ID
*
Signature
*
Submit
Should be Empty: