VENTURA COUNTY MEDICAL CENTER FAMILY MEDICINE RESIDENCY PROGRAM

We are full spectrum Family Medicine.
Our graduates are empowered to serve with continuity of care in all settings, valuing all peoples.

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(805) 652-6228

MEDICAL STUDENT EXTERNSHIP APPLICATION

First Name

Last Name

Pronouns

Phone

Mailing Address

Medical School

Anticipated Date of Graduation

Photo

Please upload a current passport-type photograph of yourself.

Upload supported file (Max 15MB)

USMLE Step 1

USMLE Step 2

COMLEX Step 1

COMLEX Step 2

Have you ever failed or had to remediate a medical school course?

Yes

Have you ever failed the USMLE Step 1 or COMLEX Part 1?

Yes

Have you ever taken a leave of absence from medical school?

Yes

Explanation

Year in medical school during requested rotation

Rotations begin on a Monday (or Tuesday if Monday is a holiday) and end 2, 3, or 4 weeks later on a Friday. Enter your preferred start date here.

Preferred end date

In case your preferred dates are unavailable, please provide a second choice.

Second Choice End Date

Please rank your preference of rotation(s). Four-week externships are divided into 2 two-week rotations. We try to accommodate preferences when possible. First Choice:

Second Rotation Choice

Third Rotation Choice

Fourth Rotation Choice

Fifth Rotation Choice

Sixth Rotation Choice

Seventh Rotation Choice

Are you planning to match in Family Medicine

Yes

Are you planning to apply to our program for residency?

Yes

Will you need help finding a place to stay during your externship?

Yes

Please include a brief personal statement describing your interest in broad spectrum Family Medicine and our residency program.

Are there questions you'd like us to address when we contact you?

Ventura County Medical Center Family Medicine Residency Program

300 Hillmont Ave, Building 340, Ventura, CA 93003