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Air Force Rotation Request
Please complete this form to request a rotation or interview at the Saint Louis University/Scott Air Force Base Family Medicine Residency.
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* Indicates required question
First Name
*
Your answer
Middle Initial
*
Your answer
Last Name
*
Your answer
Rank
*
Your answer
Preferred Pronoun
*
she/her
he/him
they/them
Date of Birth
*
MM
/
DD
/
YYYY
Last 4 Digits of Social
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Medical School
*
Your answer
Current Year of Medical School
*
First Year
Second Year
Third Year
Fourth Year
Year of Medical School at Time of Rotation
*
Third Year
Fourth Year
Requested Rotation/Interview Dates (Please Be Specific)
*
Your answer
AF Affiliation
*
Active Duty
USUHS
HPSP
Other
Other:
Will you be rotating on orders or as a civilian?
*
Orders
Civilian
Unsure
Please Select All That Apply
*
Rotation
In-Person Interview
Phone Interview
Other:
Required
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