Yale School of Medicine

Visiting Student Elective Program

Application FAQs:
Required Documents and Deadline:

1. Application Deadline - Your application should be submitted 4 - 6 months before the start of your chosen elective. Application received later
than the 4 month deadline will not be considered.

2. Letter of support from the Dean of the medical school, including verification that student is in the final year of medical school and current class
rank. The dean's letter must be written on the medical school's stationary, with the school's seal, the dean's original signature and e-mail
address. The dean's letter must include the applicants current class ranking. The letter must be in English or accompanied by an English
translation.

3. Copy of students current transcript written in English or accompanied by an English translation, demonstrating completion of required
Clerkships.

4. Curriculum vitae (CV) that lists students education, publications, and other professional accomplishments.

5. Letter of recommendation from a member of the faculty at students medical school who has observed student's clinical skills. This letter, in
English or with English translation, must be submitted with the faculty member's original signature on medical school's official
stationary. (preferably from a faculty member that is in the same specialty you are applying for)

6. Yale University Pre-entrance Health Forms (3 pages) with translation in English, of student immunization record and documentation. lf student
PPD is positive, student must INCLUDE a copy of chest x-ray report in English or with English translation. The OIMSE requires documentation of
a quantitative hepatitis B surface antibody titer. A non-quantitative result (i.e. "Positive") is not acceptable.

7. Proof of health insurance while on the clinical elective at Yale. This certificate should be obtained from students health insurance company.*

8. Personal statement describing students career goals, how this experience will help student achieve them, and what student has accomplished
thus far in pursuit of those goals. Also included should be what cultural opportunities student will pursue during his/her stay.

9. A record of student TOEFL scores is REQUIRED if student is a non-native English speaker.

* Proof of Health Insurance is not required at application, but must be submitted upon acceptance.

What elective should I choose?

Please review our elective descriptions carefully and select the elective that is best suited to your interest. You will need to provide
the elective sub-specialty as your elective choice. Please do not enter Internal Medicine, Surgery, etc.

Can I complete my rotation outside of the pre-set YSM elective dates?

Unfortunately no, students will need to complete their clinical rotations during the pre-set dates listed on the application. Please note
that we will only sign-off on paperwork that have the assigned pre-set YSM elective dates. We cannot alter paperwork to
accommodate home institution or medical board requirements.

When will I be notified of my application final decision?

Students are notified no later than two months prior to the start of the elective rotation, in most cases. We will do our best to
get notifications out to students as early as possible.

Will I be provided application status updates?

Due to the large number of applications and application inquires, we do not provide intermittent application status updates. Once a
final decision is made students will be notified.

Do I need contact an YSM faculty member prior to submitting my application?

No, contacting a faculty member will not secure students a clinical rotation. Our application askes if a student has had a previously
established relationship with a faculty member. We use this information to notify the faculty member that we have received an
application.

Is there an application fee required to submit an application?

Currently we do not require an application fee to submit an application, however, should you be accepted there is a tuition fee
payable upon acceptance of $3,100 (subject to change each AY).

Can I submit more than one application?

No, only one application will be considered.

 Yale School of Medicine
Visiting Student Elective Program

Student Information (required):

Name: ________________________________________________________________________ Female/Male: ______

Last First Middle

Passport Number (required): ________________________________Birth Date: ______/_____/_________ (mm/dd/yyyy)

Personal Mailing Address: ___________________________________________________________________________

Street Address City State Zip Code

Email: ____________________________________________________________________________________________

Telephone: (____) ______________________________________ Cell Phone: (____) _____________________________

Nationality: ________________________________________________________________________________________

Medical School Information (required):

Name of School: ____________________________________________________________________________________

Mailing Address: ____________________________________________________________________________________

Street Address City State Zip Code

Name of Dean: Applicants Current Class Rank: __________________

Deans Office Telephone: (____) ________________________ Fax: (____) _____________________________________

Deans Email: _____________________________________________

Elective and Block Preference Academic Year 2016/2017 (required):

Please select up to 2 elective choices:

(1) ____________________________ (2) ______________________________

Four week block options: 07/18/2016 08/12/2016

08/15/2016 09/09/2016
I am choosing (required): 09/12/2016 10/07/2016 We are currently only accepting Visiting
One (1) elective ______ 10/10/2016 11/04/2016 Students through the November 2016
Two (2) electives ______ 11/07/2016 12/02/2016 rotation.

Please select your preferred

block dates from the list of
options above: (1) _____________________________ (2) ______________________________

I have or will purchase health insurance and will provide proof of insurance before beginning the elective.

Student Signature: _____________________________________________ Month __________ Day ______ Year _____

To be completed by Applicants Medical School

This is to certify that the person named above is a fully matriculated medical student in good standing, has excellent English
language skills sufficient to complete a clinical elective at YSM, and will be in his/her final year of medical school at the time of
the elective periods chosen above. You also certify that this applicant is approved through your institution to complete the
clinical electives applied, during the requested dates, should they be accepted.

Students must provide their own personal health insurance.

(Required)
Official Signature: _____________________________________________ Month __________ Day ______ Year _____
 Supplemental Form
For Visiting Student Elective Program
Page 1

Please print or type:

Name:
Last First Middle
Have you spoken with or corresponded with a faculty member at Yale? Yes No

If yes, with whom?

Have you completed all basic science courses? Yes No

Are you in your final year of medical school? Yes No

Date of anticipated graduation (required).

Number
Yes No
Have you completed a course of clerkship in (required): of
Patients
1) Physical Diagnosis (required)

(physical examination and history taking)

2) Inpatient Internal Medicine

3) Outpatient Internal Medicine

4) Neurology

5) Obstetrics & Gynecology

6) Pediatrics

7) Psychiatry

Yes No

When you participated in your clerkships:

Did you take histories and perform physical exams?
Did you write up the above for inclusion in the patients record?
Did you present the patients clinical problem(s) to an attending physician?
Did you place your progress notes in the patients record?

English Language Skills: Excellent Good

Knowledge of English:
Written
Spoken
 Supplemental Form
For Visiting Student Elective Program
Page 2

Knowledge of Medical English:

Yes No Score Date

Have you had English as a primary language in a patient care setting?

Have you taken the TOEFL? (required for non-native English speakers)

Have you taken Step 1 United States Medical Licensing Exam?

Please submit a personal statement describing your career goals, how this experience will help you achieve them, and
what you have accomplished thus far in pursuit of those goals. Also include what cultural opportunities you will pursue
during your stay. Please submit this statement in a separate document that is double-spaced and no more than one
page (approximately 250 words).

Required:

Your Signature

Official Signature
Dean of Your Medical School

Please Print or Type Deans Name

Certification (Seal)

Please note we will not process incomplete applications, please review your application to ensure that all REQUIRED
fields are complete.