Application for US Clinical Rotation
(Fill out separate forms for each rotation)
Applicant's Name
*
First Name
Last Name
Applicant's Phone/WhatsApp
*
-
Country Code (+)
Phone Number
Applicant's Email
*
example@example.com
Applicant's Medical School Name & Address
*
Street Address, City, State, Country
City, State/Province
State / Province
Zip Code
Applicant's Expected or Completed Month & Year of Graduation
*
e.g., June 2024
Applicant's Expected Year of ERAS Application
*
e.g., September 2026
Clinical Rotation Site: Hospital Name
*
e.g., AdventHealth Florida and Borland Groover Foundation (Copy & Paste from "Availability" Table)
City & State
*
e.g., Port Orange, FL (Copy & Paste from "Availability" Table)
Clinical Experience Type
*
e.g., Gastroenterology (Copy & Paste from "Availability" Table)
Do you have a valid visa? (If NO, then please fill up Visa Application Support for US Clinical Rotation form from the link below.)
*
Visitor Visa (B-1/B-2)
Student Visa (F-1)
Research Scholar and Professor Visa (J-1)
EAD or Green Card or US Citizen
No Valid Visa (https://pci.jotform.com/form/261612212574147)
Preferred "Month & Year" for Rotation (Write one specific month after discussing availability with the team, DO NOT fill up this form if a specific month is not decided.)
*
e.g., September 2025
Checklist
*
Passport Biographical Page (Mandatory)
US Visa (Mandatory)
Recent photo (Mandatory)
Proof of medical school enrollment OR degree certificate/transcript (Mandatory)
USMLE exam score report
Valid health insurance
HIPAA certificate (Mandatory)
Recent immunization records, either vaccination titers or vaccination history signed by a physician (with proof of COVID-19 vaccines and influenza shots) (Mandatory)
Upload Documents With Clear File Name
*
Browse Files
Cancel
of
My Products
*
prev
next
( X )
Application -
$1,000.00
$
1,000.00
The application fee includes: application processing, reservation confirmation, hospital invitation letter (visa support), acceptance letter (port-of-entry support), hospital badge (if required), self-paced clinical research program, publication submission support, and LoR drafting and processing.
4 Weeks US Clinical Rotation -
$1,500.00
$
1,500.00
Enter coupon
Apply
Subtotal
$0.00
$
0.00
Tax
$0.00
$
0.00
Total
$0.00
$
0.00
Credit Card
Note: Please specify the rotation details clearly to ensure accurate scheduling, and describe any concerns you may have regarding the rotation.
I have discussed the details of this rotation with the IFMGE team. I have paid the application fees and clinical rotation fees. (Non-refundable)
*
Yes
Signature
*
Continue
Continue
Should be Empty: