Please fill out our online application formWe prefer online submissions, but if you are unable to use the form, please email us at firstname.lastname@example.org Your Full Name (First/Last, Given/Surname) Your Email Address Address -- No. & Street, City, State/Province, Country, Postal Code Your City, State & Country Telephone (include country code) Your Citizenship Name of University/Medical School Address of University/Medical School Medical School Start Date in (DD-MM-YYYY) Format: Medical Graduation or Projected Graduation Date in (DD-MM-YYYY) Format: Are you ECFMG certified? YesNot YetNo, Not Planing To Certify When are you planning to submit your application for the USMLE match in (DD-MM-YYYY) Format: Have you applied to match in previous years? YesWill be applying for the first timeNo, Not Planing To Apply You are interested in? Standard, hands-on, on-site rotationTelemedicine Select ON-SITE, HANDS-ON REQUESTS, please indicate which specialty (on-site ONLY) NonePaediatricsInternal MedicineNeurologyFamily MedicinePsychiatryObstetrics/GynecologySurgeryEmergencyRadiologyOther If Other Select TeleRotations REQUESTS, please indicate which specialty (TeleRotations ONLY) NonePaediatricsInternal MedicineNeurologyFamily MedicinePsychiatryObstetrics/GynecologySurgeryEmergencyRadiologyOther If Other When would you like to begin your rotations?(choose any Monday) in (DD-MM-YYYY) Format: Select what You Are requesting For: One 4-week rotationTwo 4-week rotationsThree 4-week rotationsOther Please add any additional information here about your request: How did you hear about TeleRotations / R&T IMG Village? A FriendSearch Engine, Like GoogleSocial MediaSocial Media AdsUSMLE-forumsother Upload Your Resume Here Upload a scan of the passport page that has your photo on it (or state ID for US residents). Upload Medical school diploma or transcripts (graduates) or letter of good standing (current students). Your message (optional) By checking on this form you accept that the details provided in this form are 100% true.