Botsford Hospital
28050 Grand River Ave.
Farmington Hills, MI 48336-5919
(248) 471-8000
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Medical Student Rotation Application

Externships for MS3 generally will not be scheduled during the months of June-Dec but may be considered on a case-by-case basis.

Fax: (248) 471-8837

Note: On February 1, 2014 we will begin scheduling rotations through December 2014. Please do not submit applications for July 2014-December 2014 prior to February 1st. This is an application for rotation and is not guaranteed until you have received confirmation.

First Name:
Last Name:
Middle Initial:
Gender: M F
Email Address:
Date of Birth:
Last 4 SSN:
Medical School:
Year: MS3 MS4
Rotation Requested:
Rotation Dates Requested (First Choice):
Rotation Dates Requested (Second Choice):
Rotation Dates Requested (Third Choice):
Have you rotated here before? If so, what service and when?

Have you had a Scrub Procedure Class?

Require Housing? Yes No
Your Field of Interest:
COMLEX Board Scores Part 1 Part 2
Have you failed either COMLEX Part 1 or Part 2? Yes No
Are you considering applying to one of our programs? Yes No
What is your current class ranking and/or GPA?