Vauury Tanner CLERKSHIP APPLICATION Basie Criteria: 7), Students must be curenty enrolled and in good standing ina LCGME approved medical schol 2 Must be 4” year medial student at the tne of clerkship. '3)USMLE score of 210 or higher. COMLEX scare of 420 or higher. ‘With applieaton, students must provide letter of good standing and proof of abit coverage from ther Sponsoring school/nsttution, immunization fecrds, and submit @ completed background check form (@o not date this form). We cannot schedule your rotation without all of #4. ‘Annual Schedule: Four week rotations, August to February, up to four students per rotation (two {intemal Medicine, two Family Medicine). ‘August 24 - September 18 September 21 - October 16 ‘October 19 - November 13 November 16 - December 11 ‘December 14 ~ January 8 January 14 ~ February 5 February 8 ~ March 4 “Applicant Name (ast ist, Ful middle): Date of Birth: Test four of Social Security SSCS St Walling Address: i Phone: “Telephone (day): [resone Toe ‘Email Address a | Date of Medical School Graduation: Have you taken Boards Parti: Ives LINo if yes, score: " Antidpated future specialty (known): ———SSSSCSCSCSCS~S~S~S« referred Starting Date for Clerkship (rank up to three choices ist ‘nd ad ease rank your preference for Cl 7 Internal Medicine (inpatient experience with residents and faculty) Tramily Meccne ouster pence nel andor indeed i) 13 Yo Intend oor hve you piled ou program Brough ERAS: Yes NoT-TUndeded ‘Return Application and Required Decumentation to! Patty Long ‘patty lona@tenethealth.com 441 Florida Avenue, Modesto, CA 95350 11400 Florida Avenue, Suite #200, Modesto, Ca 95350 (mailing) 209.576.3580 F: 209.576.3597 J