International Visiting Student Application

International Visiting Student Application

Thank you for your interest in completing an elective at the Icahn School of Medicine at Mount Sinai (ISMMS). All electives open to International Students are listed on our website. Please do not contact the clinical department directly. Not all students will be accepted for an elective and this is based on multiple factors, including availability. If any portion of the application is not completed or not translated into English, the application will be automatically rejected. Students will be notified of their acceptance or rejection for an elective at least two months in advance of the start date. Please refer to our website and review it thoroughly. If you have any questions regarding this application, please email visiting-students@mssm.edu.
Name*

First NameLast Name
Email*
example@example.com
Date of Birth*

MonthDayYear
Date
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Country CodeArea CodePhone Number
Citizenship*
Gender*
Medical School*
Location of Medical School*
City, Country
What year of medical school will you be in during the dates you are applying for?*
Eligible students must be in their second to last or final year of medical school if accepted for an elective at ISMMS.
How long is the program you are in?*
Select the Core Clerkships you will have completed at the time of your proposed elective. Core Clerkships are CLINICAL ROTATIONS that every student must complete at their home school before they can graduate. (Select all that Apply)*

AnesthesiologyDermatologyEmergency MedicineFamily MedicineInternal MedicineNeurologyObstetrics and GynecologyPediatricsPsychiatryRadiologySurgeryOther

Official School Transcript
Official School Transcript

The Official School Transcript must list all courses you have completed so far in medical school. If the original document is not in English it must be officially translated to English.
Official School Transcript*

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Letter of Good Academic Standing
Letter of Good Academic Standing

This letter must be in English on the school's letterhead with a signature of a school official. The letter must state that you are in good academic standing and must include your expected graduation date.
Letter of Good Academic Standing*

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Letter of Recommendation
Letter of Recommendation

At least 1 letter is required, only 2 will be accepted. These recommendations should be from faculty members who have directly observed your clinical skills and abilities from an inpatient setting. The Letter of Recommendation must be on the official school letterhead and in English.
Letter of Recommendation #1*

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Letter of Recommendation #2 (Optional)

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Curriculum Vitae (CV)
Curriculum Vitae (CV)

The CV is a summary of your qualifications and experience. This should be uploaded in English.
Curriculum Vitae (CV)*

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Biographical Passport Page
Biographical Passport Page

A scan or picture of the biographical passport page must be uploaded.
Biographical Passport Page*

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TOEFL Test Score
TOEFL IBT Test Score

Only students who are from non-English speaking countries AND go to a medical school that does not teach in English are required to submit their TOEFL IBT Test Score. A minimum of 22-30 in each category is required applications to be considered for acceptance. If you are from an English speaking country and/or go to a medical school that teaches in English, an official letter from the Dean of your school confirming your English Language Proficiency should be submitted instead.
TOEFL Test Score or Letter of English Proficiency*

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Personal Statement of Interest
Personal Statement of Interest

This statement succinctly details your motivations and goals. This is not required but some electives do recommend it.
Personal Statement of Interest (Optional)

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USMLE Step 1 Score Report
USMLE Step 1 Score Report

If you have taken the United States Medical Licensing Examination (USMLE) Step 1 Exam, submit a copy of your score. This is not required but some electives do recommend it.
USMLE Step 1 Score Report (Optional)

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Elective Requests

In this section you will select the elective(s) you're applying for and the date block. There is no guarantee that you will be accepted for an elective, this is based on qualifications and availability. Dates of electives may also change based on availability. If you are applying for more than one elective, these must be taken consecutively. We only offer elective to be taken during the designated dates below.
How many electives are you applying for?*

1 (4 weeks)2 (8 weeks)3 (12 weeks)
Elective Date Range

If you are applying for more than one elective please select different, consecutive date ranges below.
Start Date of Elective (Must Start on a Monday)

MonthDayYear
Date
End Date of Elective (Must End on a Friday)

MonthDayYear
Date
Elective Date Range # 1*
Elective Date Range # 2*
Elective Date Range # 3*
If you have any comments you'd like to add regarding your date availability please add them here.
Elective Preferences

If you are applying for more than one elective, please select different electives below.
Elective Preference #1*
Elective Preference #2*
Elective Preference #3*
If you have any comments you'd like to add regarding your elective preferences please add them here.
Application Fee

An application fee of $1000 is required. If you have trouble completing payment online we also accept Bank Draft, Money Order, Cashier's Check or Traveler's Check which can be sent to Icahn School of Medicine at Mount Sinai, Re: International Visiting Student- Application Fee, One Gustave L. Levy Place, Box 1255, New York, NY 10029
Payment Method*

Credit or Debit CardBank DraftMoney OrderCashier's CheckTraveler's Check

Application Fee ($1000)

USD

Credit or Debit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

International Visiting Student Application

Official School Transcript

Letter of Good Academic Standing

Letter of Recommendation

Curriculum Vitae (CV)

Biographical Passport Page

TOEFL IBT Test Score

Personal Statement of Interest

USMLE Step 1 Score Report

Elective Requests

Elective Date Range

Elective Preferences

Application Fee