Your Full Name:
Name of your Medical School:
Your Scheduled Interview Date:
Are you a categorical or preliminary applicant? Categorical Preliminary
Do you have career plans after Internal Medicine? Yes No If so, in what field?
Please note that you are welcome to stay at any hotel within the Rochester area, but we will only pay for one nights' stay (the evening prior to your interview) at the Holiday Inn Express on Jefferson Road in Rochester, NY.