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Kaiser Permanente Orange County Family Medicine Residency Program -- Application for Virtual Rotation
Please complete this application form for consideration to participate in our Virtual Family Medicine Rotation. Please see this site for details about the Rotation:
https://www.kpocfmresidency.com/med-students.html
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Intro video to KPOC FM Residency's Virtual Rotation
First Name
*
Your answer
Last Name
*
Your answer
Email address
*
Your answer
Phone number
*
Your answer
Current year in school (only 3rd or 4th year please)
*
Your answer
Name of Medical School
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Your answer
Expected graduation year
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2022
2023
Other:
Please provide all USMLE and COMLEX Board Scores, including any failed attempts
*
Your answer
Preferred and available rotation dates (please rank in order of preference)
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First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
9/6-9/17
9/20-10/1
10/18-10/29
11/1-11/12
11/29-12/12
First Choice
Second Choice
Third Choice
Fourth Choice
Fifth Choice
9/6-9/17
9/20-10/1
10/18-10/29
11/1-11/12
11/29-12/12
Committed to becoming an FM Physician and Applying to the Match in Family Medicine
*
Yes
No
Maybe
Thank you SO much for your interest! Please let us know if you have any questions or need anything.
Your answer
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