HARVARD MEDICAL SCHOOL

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Exclerk Application Information

Last: Ehsan Date of Birth: 10/16/1994
First: Ayesha Gender: F
Middle: Emergency Contact: Amy Rassier
Email: ayesha_ehsan26@yahoo.com Emergency Phone: +14064809662

Clerkship Months / Dates Requested

Clerkship Date(s)
Feb 02/04/2019 - 03/03/2019

Clerkships Requested
Pref Course Title When Offered Location
1 NN501M.1 Advanced Study in Neurology Offered: Feb BIDMCE
2 NN501M.3 Advanced Neurology Offered: Feb MGH
3 NN505M.3 Pediatric Neurology Offered: Feb MGH
4 NN505M.7 Child Neurology Offered: Feb CHMC
5 PS530M.3 Lurie Ctr:Multidisciplinary Clinic for Children, Offered: Feb MGH
Adolescents & Adults w/ Autism Spectrum Disorder
6 ME556M.J Sleep Disorders Medicine Offered: Feb MULTI
7 ME529M.6 Clinical Management of the Addictions Offered: Feb CAM
8 ME540M.3 Outpatient Care of Patients w/ Down Syndrome Across Offered: Feb MGH
Age Spectrum
9 PA506.23 Clinical Clerkship in Neuropathology Offered: Feb BWH
10 NN503M.3 Advanced Study in Neuropathology Offered: Feb MGH
11 PS501M.10b Advanced Clerkship in Diagnosis & Treatment of Major Offered: Feb MCLH
Psychoses
12 PS507M.23 Women's Mental Health Offered: Feb BWH
13 ME513M.11 Clinical Infectious Disease Offered: Feb MTAH
14 ME501M.3 Advanced Medicine Clerkship Offered: Feb MGH
15 ME533M.J Understanding Lupus--A Multidisciplinary Approach to Offered: Feb MULTI
Systemic Disease

Current Medical School Information

Medical School Attending: Services Inst. of Medical Sciences, Pakistan

Expected Degree: MBBS
Expected Degree Date: 03/07/2019
Name of School Registrar: Prof.Dr.Mahmood Ayyaz

Print Date: 9/1/2018 1 of 2

HARVARD MEDICAL SCHOOL
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Exclerk Application Information

Title of School Registrar: Principal
Registrar Phone Number: +924299205517
Registrar Email: principalsofficesims@gmail.com
Mail To: Prof.Dr.Mahmood Ayyaz
Address Line 1: ghous-ul-azam, jail road, Lahore
Address Line 2:
City: Lahore
State:
Zip Code: 54000
Province: Punjab
Country: Pakistan

Mailing Address Permanent Address

Line 1: Shadman Colony, Sook Line 1: Shadman Colony, Sook
Line 2: House, H#A-91, S#A/3 Line 2: House, H#A-91, S#A/3
Line 3: Line 3:
City: Gujrat City: Gujrat
State: State:
Zip Code: 50700 Zip Code: 50700
Province: Province: Punjab
Country: Pakistan Country: Pakistan
Phone: +9253-3709162 Phone: +9253-3709162

Optional Information

Citizenship: Foreign National

Citizenship Country: Pakistan
(U.S. Only): Do you consider yourself to be Hispanic/Latino:
(U.S. Only): In Addition, select one of more of the following
racial categories to describe yourself:

Print Date: 9/1/2018 2 of 2