Anesthesia Extern Questions

Applicant Information

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Supplemental University of Colorado Anesthesia Extern Questions

Medical School*

Medical School start date*

Medical School anticipated end date*

What type of anesthesia rotation(s) have you completed*

How many weeks of anesthesia experience have you completed

USMLE step 1 score (Pass / Fail)

USMLE step 2 score

Class rank (percent, third, quartile, etc.)

Do you have any medical honors or advanced degrees (AOA, Gold Humanism, PhD, MBA, MPH, etc.)

Why are you interested in doing a rotation at the University of Colorado*

What do you hope to gain from an externship at our program?*

In accordance with The Family Educational Rights and Privacy Act (FERPA), I authorize the release of information provided to the University of Colorado Department of Anesthesiology. I understand that my personal information will no be shared with a third party.*

Yes No

Are you a US Citizen?*

Yes No

Please list all interested rotations, should your first preference be full*

Additional rotation dates, should your first preference be full*

Upload CV*

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Upload a LOR from the dean or a physician of choice (required)*

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