Accelerated Clinical Experience (ACE) Program Form

Accelerated Clinical Experience (ACE) Program Application
Applicant Information
Full name*

First NameMiddle NameLast Name
Gender*

FemaleMaleNon-binaryPrefer not to respond
Gender*
Date of birth*

MonthDayYear
Country of birth*
Current address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
E-mail address *
Phone number*

Country CodeArea CodePhone Number
Have you visited the United States before?*

YesNo
What method of transportation would you plan to use while in San Diego for an ACE Rotation?*

Personal Vehicle (driving your own car/CA Driver's License)Public Transportation (city bus, shuttle, trolley, etc. )Ride-Sharing Transportation (i.e. Uber, Lyft, Taxi Cab, etc.)Other
If admitted into the ACE Program, I will be able to provide documentation (in English) of my WHO-approved COVID-19 vaccination and booster before my program start date. *
ACE Program participants will also be required to provide documentation for other UC-required vaccinations (influenza, TB, MMR, Hepatitis B, etc.). If you have any questions regarding vaccination status before submitting your application, please reach out to us at hsinternational@ucsd.edu.
How did you learn about this program?*
Please specify*
Educational Background
Name of medical school*
Country of medical school location*
Country of medical school location*
Graduation (Expected) Date*

MonthDayYear
Graduation date*
Please enter your graduation date*
Are you affiliated with or employed by any institution in your home country? (i.e. SACM, University, hospital, medical city, ministry, military/defense, etc?)*
Availability

Please Note: We are currently only accepting applications for a minimum of eight weeks within the same specialty.
If YES, please specify:
For how many months you would like to participate?*
Number of months
For how many weeks would you like to participate?*
Year you're interested in*
Year
Preferred start date*
Specialty of interest - please list at least 3 choices. For IM, please provide subspecialties
Please select three unique specialties.

If your specialty of interest is not listed in the drop-down menu, please select "Other". Your selections will be discussed during your interview.
Specialty (1st choice)*
Specialty (2nd choice)*
Specialty (3rd choice)*
For this duration, you will be required to obtain B1 (visitor visa) - our office will work with you. For more information, please visit our website hsi.ucsd.edu*

I do not hold a US Passport and I understand that I will need to secure a visa for entry into the USI have dual-citizenship and/or an ESTA waiver and do not require a visa for entry into the United States
Do you have a travel authorization to travel to the US or a B1/B2 visa valid for the dates you will participate in the ACE program? *
Preferred Starting Month

January 2024February 2024March 2024April 2024May 2024June 2024July 2024August 2024September 2024October 2024November 2024
Please describe the anticipated benefits of the ACE Program in helping you achieve your career goals*
Documentation
Scanned Copy of Your Passport's photo page*

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Scanned copy of your passport's photo page*

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CV*

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Transcripts*

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Other attachments (USMLE Score Reports, LORs, etc)

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Accelerated Clinical Experience (ACE) Program Application

Applicant Information

Educational Background

Availability

Documentation