Graduate Medical Education Rotation or Observership Request

This application is for medical students needing a medical rotation or for a visiting physician looking for observation hours for experience.

Preferred Location

Preferred Location Rock and Walworth Counties, WI and McHenry County, IL Winnebago and Ogle Counties, IL
Rotation or Observership

Rotation or Observership Clinical Rotation Medical Observership (30 days)
Have you previously contacted someone at Mercyhealth about this request?

Have you previously contacted someone at Mercyhealth about this request? Yes No
Who did you contact?
Name Name First Last
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Phone - ### - ### ####
Email
Education History
Name of Medical School
Address of Medical School Address of Medical School
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Clinical Coordinator Name Clinical Coordinator Name First Last
Contact Phone Number Contact Phone Number - ### - ### ####
Clinical Coordinator Email
Year of Medical School
Rotation Requested
Dates Requested for Rotation
Objectives of this Rotation
Which area of medicine are you currently thinking of pursuing for residency?