Office of Medical Education

Elective Application Form

Elective Application Form

Check List:

  1. Online Application Form (found below)
  2. Four documents listed below
  3. Official Transcript
  4. Medical Elective Form (Medical Students)

Rotation Learner Contract
Student Honor Code
Confidentiality Agreement
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 gharmon2@jhmi.edu.

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.

Personal Information


Mailing Address

Contact Information


Education Information

Not yet in Medical school? Put N/A in the Medical School Name field, but still provide an anticipated graduation date.


Rotation Information

Please provide dates that span 14, 21 or 28 days.


Elective Preferences

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Office of Medical Education
Johns Hopkins All Children’s Hospital
601 Fifth Street South, Suite 608
St. Petersburg, FL 33701
Phone: (727) 767-4106
Fax: (727) 767-8804

Contact us

Johns Hopkins Medicine has worked very closely with All Children's to create the nation’s most outstanding academic environment for pediatrics.

Jonathan Ellen, MD
President and Vice Dean for All Children's Hospital

For somebody who is unsure or undecided, which is expected during residency, you want to be given all the doors and All Children’s really has all the doors.

Raquel Hernandez MD, MPH
Director of Medical Education ACH JHM
Johns Hopkins University School of Medicine