Southern Illinois University School of Medicine

Class of 2015


Elective Scheduling Requests for July 7, 2014 - May 15, 2015

Name:       Advisor: 


Wk#    Date

Wk#    Date

Wk#    Date

Wk#    Date

01  July 7, 2014

14  October 6

27  January 5, 2015

40  April 6

02  July 14

15  October 13

28  January 12

41  April 13

03  July 21

16  October 20

29  January 19

42  April 20

04  July 28

17  October 27

30  January 26

43  April 27

05  August 4

18  November 3

31  February 2

44  May 4

06  August 11

19  November 10

32  February 9

45  May 11

07  August 18

20  November 17

33  February 16

46  May 18

08  August 25

21  November 24 (Thanksgiving)

34  February 23

47  May 25

09  September 1

22  December 1

35  March 2

48  June 1

10  September 8

23  December 8

36  March 9

49  June 8

11  September 15

24  December 15

37  March 16 

50  June 15

12  September 22

25  December 22 (Holiday)

38  March 23

51  June 22

13  September 29

26  December 29 (Holiday)

39  March 30

52  June 29

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: March 25, 2014

This registration request meets the requirements for the fourth year elective program as stated in the elective policy for the Class of 2015.


 

Student Signature:

_________________________________________________________

Date:

_______________________

 

Elective Advisor Signature:

_________________________________________________________

 

Date:

________________________