Elective Registration Form

Part A: General Information

* Name of University:

* Current year of study:

* Total Academic Years of your Program:

* Date of Birth:

* Country of origin:

Part B: Number of Elective Rounds

Please write down the departments to which you are applying for elective. Please include the exact dates(from_ to_) and a total number of weeks.

For example:

First choice: Internal Medicine, from October 18, 2020, to October 29, 2020, a total of two weeks.

Second choice: Surgery, from November 1, 2020, to November 5, 2020, a total of one week.

First Round:

Second Round:

Third Round:

* שדות חובה

צ'ט