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Mailing Address: International Elective Application Form

This document is an international elective application form for Cornell medical students. It requests personal information from applicants, including name, date of birth, citizenship, contact details, medical school and expected graduation date. Applicants must also select 6-9 elective choices with available dates and submit documents including proof of payment, CV, health statement, verification from home institution, statement of intent, passport photo and official transcripts. Proof of health and malpractice insurance will also be required if the application is approved.

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Mohammad Mansour
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24 views

Mailing Address: International Elective Application Form

This document is an international elective application form for Cornell medical students. It requests personal information from applicants, including name, date of birth, citizenship, contact details, medical school and expected graduation date. Applicants must also select 6-9 elective choices with available dates and submit documents including proof of payment, CV, health statement, verification from home institution, statement of intent, passport photo and official transcripts. Proof of health and malpractice insurance will also be required if the application is approved.

Uploaded by

Mohammad Mansour
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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INTERNATIONAL ELECTIVE APPLICATION FORM

Complete and return application and attachments to:


https://transfer.weill.cornell.edu/form/international-students
DUE DATE: 6 Months prior to the start of the earliest elective choice
Do not submit application more than 6 months in advance of first elective start date

A: PERSONAL INFORMATION
To be completed by student. Please type. Handwritten applications will not be accepted.
NAME AS IT APPEARS ON PASSPORT:
Last First Middle Male [ ] Female [ ]
Date of Birth [MM/DD/YEAR] Citizenship
Email address Telephone Number
Mailing Address
Street Apt #
City
State Zip
Country
Name of Undergraduate School (if applicable):
Name of Medical School + Country Expected Date of Graduation (mm/yy):
Degree to be Awarded:
School Contact
Name Email
Emergency Contact
Name Telephone

B: ELECTIVE CHOICES AND DATES


Use catalog to find the elective codes ex. MEDC 8108 01 NYP or EMER 8304 07 NYQ (see key to the
right for explanation). Only list each elective once with recommended 6-9 electives in order of
preference. Electives will be considered for all available dates listed. Please note the maximum possible
time allowed for elective is 8 weeks.

AVAILABLE DATES
(mm/dd/yy - mm/dd/yy)
1) 2) 3)
ELECTIVE CHOICES
(Department code and specialization code, i.e. MEDC 8108 01 NYP or EMER 8304 07 NYQ)
1) 2) 3)
4) 5) 6)
7) 8) 9)
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: ________________________________


Attach in PDF format:
 Non- refundable Application Fee $300 USD ***ONLY PayPal and Personal Checks/Money Orders accepted*** (submit proof of payment)
 Curriculum Vitae (with photo)  Health Statement Form (1 page)
 Dean/Registrar Verification Form  Statement of Intent (one page max)
 Dean’s Letter  Photo page of passport
 Official Transcript with Grades/Marks (and grading system key in English)

1300 York Avenue, New York, NY 10065


*****If approved you will be required to submit Health Insurance Policy and Malpractice Insurance Policy*****

402 East 67th Street, New York, NY 10065 | T. 646.962.8666 | F. 212.988.1348 | E. [email protected]
1300 York Avenue, New York, NY 10065

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