Clinical Education and Training Office M4 Rotation Elective

Thank you for your interest in the St. Jude Children's Research Hospital M4 Rotation Elective. We encourage applicants from LCME accredited Medical Schools. To qualify for the M4 Rotation Elective, you must have completed your 8-week rotation in Pediatrics. In order to facilitate your request and determine your eligibility for our program, we require that you complete and return this form three (3) months prior to your requested start date. You must also attach all of the documents listed at the end of this form.

Asterisk (*) indicates a required field.

Contact Information

First Name*

Middle Initial

Last Name*

Email Address*

Phone Number*

City*

State/Province/Region*

Country*

Education

Degree*

Medical College*

Is your school a member of VSAS?*If not, we will need to establish an affiliation agreement with your University or Institution.

Yes No

Anticipated date of graduation*

Proposed Rotation Dates

First Choice*

Second Choice*

Third Choice*

Elective

Temporary Housing

St. Jude offers apartment room rentals to our visiting trainees based on availability. The room rates are $28 per night for a shared 2-bedroom/2-bath apartment with a roommate. Payment is not due until after arrival.

Do you need temporary housing?*

Yes No

Initials*

Required Documentation

If you need to mail or FAX required documentation, please send it to:

Clinical Education & Training Office
St. Jude Children's Research Hospital
262 Danny Thomas Place, Mailstop 277
Memphis, TN 38105
fax: 901-595-4651

Current CV*

Upload Documentation Fax or Mail Documentation

Current Immunization Records*

Upload Documentation Fax or Mail Documentation

Proof of personal health insurance*

Upload Documentation Fax or Mail Documentation

Your school's evaluation form*

Upload Documentation Fax or Mail Documentation

I agree to share this information with St. Jude*
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