Elective Application Form
- Online Application Form (found below)
- Four documents listed below
- Official Transcript
- Medical Elective Form (Medical Students)
Rotation Learner Contract
Student Honor Code
Social Media Policy
Your electronically submitted application will be processed upon receiving all of the above documents and subsequently reviewed for eligibility. It will not be processed if it does not meet the eligibility requirements. Please fax your completed forms to (727) 767-8804 or email our student coordinator, Gwen Harmon at firstname.lastname@example.org.
For MEDICAL STUDENTS: Please also submit the following form to your registrar's office to complete and send to our office for elective approval.
Medical School Elective Approval Form
We look forward to seeing your application and helping you enhance your understanding of our hospital, faculty and the field of pediatrics.
Not yet in Medical school? Put N/A in the Medical School Name field, but still provide an anticipated graduation date.
Please provide dates that span 14, 21 or 28 days.