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International Elective Application Form Updated (2) Cornell

Palav Shah, an Indian citizen and 5th year medical student at GCS Medical College in India, has applied for international electives at Weill Cornell Medical College. Shah listed 9 elective choices between February and May 2019 in New York, along with required application documents including a CV, health forms, letters of recommendation, transcripts and proof of health and malpractice insurance.

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85 views2 pages

International Elective Application Form Updated (2) Cornell

Palav Shah, an Indian citizen and 5th year medical student at GCS Medical College in India, has applied for international electives at Weill Cornell Medical College. Shah listed 9 elective choices between February and May 2019 in New York, along with required application documents including a CV, health forms, letters of recommendation, transcripts and proof of health and malpractice insurance.

Uploaded by

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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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WEILL CORNELL MEDICAL COLLEGE

OFFICE OF GLOBAL HEALTH EDUCATION


INTERNATIONAL ELECTIVE APPLICATION FORM
Complete and return application to: [email protected]

A: PERSONAL INFORMATION
To be completed by student. Please print or type
NAME AS IT APPEARS ON TRAVEL DOCUMENTS:
Last SHAH First PALAV Middle SHREYANS
Preferred Name PALAV SHAH Male [ ] Female [ ]
Date of Birth [MM/DD/YEAR] 11/19/1995
Citizenship INDIAN
Mailing Address
Street 344/1 , ISHWAR KRUPA SOCIETY
Apt # SECTOR-22, GH-5
City GANDHINAGAR
State GUJARAT Zip 382024
Country INDIA
Email address [email protected]
Telephone Number +91 8238927733
Name of Undergraduate School (if applicable):
Name of Medical School + Country Degree Awarded & Exp. Date of
GCS Medical College, Hospital and Research Centre Graduation
INDIA 5TH YEAR MBBS STUDENT
Exp. Date of graduation- JUNE 2019

School Contact
Name GCS MEDICAL COLLEGE , Email [email protected]
HOSPITAL AND RESEARCH CENTRE
Emergency Contact
Name SHREYANS SHAH Telephone +91 9825297733

B: ELECTIVE CHOICES AND DATES


Use catalogue to find the elective codes ex. MEDC 8108. Only list each elective once with recommended 6-9 electives in order of
preference. The listed electives will be considered for the entirety of dates, based on availability.

Dates Elective Choices


1) 04/01/2019 - 1) PEDS 8127 10 NYP 2)MEDC 8104 10 NYP 3)MEDC 8112 10
04/28/2019 NYP
2) 02/25/2019 - 4) MEDC 8157 10 5) MEDC 8173 10 NYP 6)MEDC 8175 10
03/24/2019 NYP NYP
3) 04/29/2019 - 7)PEDS 8116 10 NYP 8) PEDS 8203 19 NYP 9)PEDS 8302 10 NYP
05/26/2019

I have read and understood the application materials. I attest that the information given in this
application is accurate and true.
Student’s Signature: _

____ __________________Date:__06/28/2018_______________________
Attach in PDF format:
 Non- refundable Application Fee $300 USD *ONLY PayPal and Personal Checks/Money Orders accepted*
 Curriculum Vitae (with photo)  Health Statement Form (1 page)
 Dean/Registrar Verification Form  Statement of Intent
 Dean’s Letter +++++++  Official Transcript with Grades/Marks
 Health Insurance Policy (after approval)  Malpractice Insurance Policy (after approval)

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