Name:

Interview Date:

1. I have made my hotel reservation:

Yes

No, I will not be staying at the hotel

• If you will be staying with a friend or family member please let me know so I can help with directions if needed.

2. I will be attending the evening dinner with the residents the night before my interview (6:30 pm transportation arranged from the hotel)

Yes

No

Number of people attending:

Name/Relationship to you of other person if applicable:

3. Are you interviewing for any other residency program in Rochester?:

Yes

No

Interview date:

4. Are you couples matching/ interviewing with another applicant?

Yes

No

If so, what program and when is their interview date?

Name

Program

Interview Date

5. Spouse/SO or another will be traveling with me and may be interested in going on the tour of Rochester at the end of the interview day. If so, arrangements will be made to have the person picked up at the hotel at between 2:45 and 3:15 pm.

Name/Relationship to you of other person if applicable:

6. Transportation:

I am flying into Rochester, New York

I am flying into Buffalo, New York

7. If you will be staying an additional day in Rochester and would like to spend more time in the hospital with a resident rounding the hospital, please let me know so I can arrange this ahead of time.

Yes

Date of additional day:

8. If there are any other details you would like me to know about, please note that below. If you would like us to try to arrange for you to meet with any particular person, or in a particular field, please note that. Please include any special information that a spouse/SO may be interested in regarding opportunities/contacts for a particular field of study, career, or personal interest.