Accelerated Clinical Experience (ACE) Program Form

Accelerated Clinical Experience (ACE) Program Application Form
Today's date*

MonthDayYear
Applicant Information
Full Name*

First NameLast Name
Gender

FemaleMaleDecline to State
Date of Birth (MM/DD/YYYY)

MonthDayYear
Date
Current Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail address: *
Phone Number*

Area CodePhone Number
Scanned Copy of Your Passport's photo page*

Browse Files

Cancelof
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.)
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. *
If admitted into the ACE Program, you will also be required to furnish documentation related to other, UC-required vaccinations (influenza, TB, MMR, Hepatitis B, etc.) If you have any questions about vaccination status before submitting your online application, please reach out to: hsinternational@ucsd.edu
Educational Background
Name of Medical School*
Country of medical school location
Graduation (Expected) Date*

MonthDayYear
Are you affiliated with or employed by any institution in your home country? (i.e. SACM, University, hospital, medical city, ministry, military/defense, etc?)*
If YES, please specify:
Availability
For how many months you would like to participate?*
Number of months
Year you're interested in*
Year
Specialty of interest - please list at least 3 choices. For IM, please provide subspecialties*
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
Preferred Starting Month*

October 2023November 2023January 2024February 2024March 2024April 2024May 2024June 2024July 2024August 2024September 2024October 2024November 2024
Please Note: We are currently only accepting applications for Fall 2022 - onward.
Positions may rotate between various medical disciplines at UCSD including but not limited to:

Internal Medicine Radiology Neonatology Pathology

Emergency Medicine Psychiatry

Surgery Family Medicine Oncology
Documentation
Upload CV*
Upload Transcripts*
Other attachments (USMLE Score Reports, LORs, etc)
Please describe the anticipated benefits of the ACE Program in helping you achieve your career goals*
How did you learn about this program?*
If you selected "Other", please specify in the field
Should be Empty:

Accelerated Clinical Experience (ACE) Program Application Form

Applicant Information

Educational Background

Availability

Documentation