Southern Illinois University School of Medicine

Class of 2014


Elective Scheduling Requests for July 8, 2013 - May 17, 2014

Name:       Advisor: 


Wk#    Date

Wk#    Date

Wk#    Date

Wk#    Date

01  July 8, 2013

14  October 7

27  January 6, 2014

40  April 7

02  July 15

15  October 14

28  January 13

41  April 14

03  July 22  (CCX)

16  October 21

29  January 20

42  April 21

04  July 29  (CCX)

17  October 28

30  January 27

43  April 28

05  August 5 (CCX)

18  November 4

31  February 3

44  May 5

06  August 12

19  November 11

32  February 10

45  May 12

07  August 19

20  November 18

33  February 17

Grad: May 17

08  August 26

21  November 25 (Thanksgiving)

34  February 24

 

09  September 2

22  December 2

35  March 3  (Doc)

 

10  September 9

23  December 9

36  March 10  (Doc)

 

11  September 16

24  December 16

37  March 17  (Match Week)

 

12  September 23

25  December 23  (Holiday)

38  March 24

 

13  September 30

26  December 30  (Holiday)

39  March 31

 

Your Neurology Clerkship rotation has already been selected and other requests will work around that course.  Also, in the spaces below, please note any SPECIFIC TIME REQUIREMENTS, i.e. clerkship deferrals/remediation that you have to make up, Pending Off-Campus dates that you are sure of, Individually-Designed and Research Electives, and Vacations.  Use the Week # and Date guide above to list time requirements in this space.  Do not # these as priorities.

Using the lines provided next to the priority numbers, list IN ORDER OF PRIORITY, not chronological order, those catalog electives you wish to take along with the length of time desired in weeks. (See completed example form copied on pink paper.)


Program Selection (Choose One):

Specialty Pathway

Undeclared


Activity or Course Title

Start Week

Duration

AM/PM Full time, Extended

Neurology Clerkship

4 weeks

* Select your Neurology Rotation
Senior CCX

2 days

* Select your CCX week
Doctoring

35

2 weeks

Full-time 2 weeks

  weeks

  weeks

  weeks

  weeks

  weeks

  weeks

  weeks

 

Priority # Course Number - Course Description - # weeks
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20

Please provide any other notes or information that you would like to have considered when your schedule request is entered:

 This form must be submitted by Friday, April 26, 2013.


CHECK YOUR NUMBERING.  You can only have one 1st priority, one 2nd priority, etc.  Forms with numbering errors may cause a delay in scheduling your courses.  Course numbers ending with:  1 indicates half-time mornings only; 2 indicates half-time afternoons only; 3 indicates full time; and courses ending in a 4 indicates Thursday afternoons (extended).

NOTE:  Before clicking on the "submit" button,

please print a copy of this form!

 

  

 

Don't forget to submit the form!!

 

 

 


Contact Us:

Chris Reavis  (Curriculum Information)
Jean Afflerbach
(Web Page)

Copyright 2013 [Southern Illinois University, Board of Trustees]. All rights reserved.
Revised: April 01, 2013

This registration request meets the requirements for the fourth year elective program as stated in the elective policy for the Class of 2014.


 

Student Signature:

______________________________________________________________

Date:

_______________________

 

Elective Advisor Signature:

______________________________________________________________

 

Date:

________________________