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Audition Rotation Application
Official First and Last Name:
No nicknames, middle names used as first names or preferred names.
Permanent Address, City, State and Zip:
Use only your school domain email address. No gmail, hotmail etc. accounts.
Contact phone number:
Please note: If your school is not listed, we will need an affiliation agreement initiated by
before you can rotate or audition at our facility. This process takes about 6-8 weeks to complete.
AT Still University of Health Science: Kirksville
Arizona COM: Midwestern University
Chicago COM: Midwestern University
Des Moines COM
Kansas City University of Medicine and Bioscience
Michigan State University: COM
Nova Southeastern University: COM
New York COM: New York Institute of Technology
Oklahoma University Center for Health Sciences
Ohio University COM
Touro University: COM: California
Touro Univesity: COM: Nevada
University of Medicine/Dentistry of New Jersey
University of New England: COM
University of North Texas Health Science
Edward Via COM: Virginia Tech
Western University of Health Science
Lincoln Memorial University: COM
William Carey COM
West Virginia SOM
Pacific Northwest University of Health Sciences: COM
Rocky Vista University: COM
Touro University: COM: New York
Pacific Northwest Univeristy
Liberty University: COM
Marian University: COM
Campbell University: COM
Enter the name of your medical school if it was not listed above.
Enter medical school graduation date.
Choose the program for which you wish to audition.
Anesthesia (2 wks only)
Internal Medicine (2 wks only)
Orthopedic Surgery (2 wks only)
Surgery/General (2 wks only)
How many rotations have you completed in this service?
5 or more
Please enter your COMLEX/USMLE scores.
Audition start date:
Audition end date:
Alternate start date
Alternate end date:
Do you need housing?
Yes, I need female housing
Yes, I need male housing
Write one short statement about why you are interested in this residency at South Pointe Hospital.