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Observership Request
Pap Society
Observership Request
Elective & Observership
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Please enable JavaScript in your browser to complete this form.
Last 2 Details
First Name
*
Last Name
*
Email
*
Phone
Birth Date
Gender
Male
Female
Street Address
Citizenship
Visa Status
Street Address Line 2
City
Region/State/Province
Medical School
Graduation Expected
Postal/Zipcode
Country
USMLE Exam Status, Pass/Fail (Scores Optional):
Step 1
Step 2 CK
Step 2 CS
Step 3
ECFMG Certification
Yes
No
ECFMG Date
Tentative Match Application Year
Observership Requested
Anatomic Pathology
Clinical Pathology
Anatomic/Clinical Pathology
Subspeciality Preference (Optional)
I have previous US based elective or observership experience
I have previous US based elective or observership experience
I have previous experience in pathology in Pakistan
I have previous experience in pathology in Pakistan
Details
Details
Location Preference 1
Month Preference 1
Duration of Observership
Location Preference 2
Month Preference 2
Location Preference 3
Month Preference 3
Checkboxes
I require accommodations
I have health insurance
Vaccination Status
Personal Statement (250 Words Max)
Disclaimer: Observership cannot be more than 3 months. Any fees incurred in the process of acquiring observership including visa shall be borne by the participant. This form does not guarantee the placement of observers.
Submit