Completing the Pre-Enrollment Request form is your opportunity to schedule two courses that you feel are very important to you in planning your future career. You may also be planning around a special event. This form is designed to allow you to choose two courses you feel very strongly about scheduling before the April enrollment session. Choose from Electives, Critical Care Selectives, Subinternships, Health of the Public (must schedule HOP during Fall enrollment, for both fall and spring semesters).
Your required Rural rotation is arranged through either Family Medicine, Internal Medicine, or Pediatrics. To schedule rural: 1. go to department, 2. work out details, and 3. complete an add slip. Special arrangements are necessary for away, “Special Programs” (talk to Melanie in ASA). Request HOP on this pre-enrollment request form only if month placement is important to your overall fourth year schedule (offered Nov, Feb, Apr).
On the form below, indicate your first choice for a maximum of two most important courses:
Each request section has a drop down menu so you may choose the course and dates you are most interested in. If the course you are interested in does not appear in the drop down menu, list your request in the “Explanation” section. The course name may not be what you expect, or that specific course may not be offered. Use the link to the course catalog to view course listings and descriptions. If you are interested in Fall KUMC courses, submit an additional request form.
In the “Explanation” section below you can indicate additional months that might be acceptable for a specific course, as well as additional courses that might be acceptable for specific dates. Explain the details and reasons for your choices in this section.
*Required Fields
*First Name:
*Last Name:
1.Course Request:
(Department / Course Number / Course Name) Administration MDAD 976 Medical Education Administration Anesthesiology ANSL 976 Anesthesiology Anesthesiology ANSL 995 Special Topics:Anesthesiology Computers LBRY 976 Med Infomatics: Microcomputer Emergency Medicine CCSL 976 Critical Care Sel:Emerg Med Emergency Medicine EMRM 976 Emergency Medicine ENT OHIN 976 Otorhinolaryngology--ENT Family Medicine FCMD 976 Adv Fam Med--Grtr Wichita Reg Family Medicine FCMD 977 Adv Family Med--Rural Kansas Family Medicine FCMD 978 Clinical Prob-Community Persp Family Medicine FCMD 979 Ambulatory Care of the Elderly Family Medicine FCMD 980 Adv Fam Med-Residency Persp Family Medicine FCMD 981 Addiction Medicine Family Medicine FCMD 982 Sports Medicine Family Medicine FCMD 983 In-Pt Maternal Care Family Medicine FCMD 995 Special Topics:Fam Med Family Medicine FCMD 998 Family Medicine Subinternship Family Medicine RLMD 976 Rural Medicine:Family Medicine Free Time Freetime Free time Internal Medicine CCSL 978 Critical Care Sel:Pulmonary Med Internal Medicine CCSL 981 Critical Care Sel:Internal Med Internal Medicine INMD 977 Pulmonary Medicine Internal Medicine INMD 979 Endocrinology Internal Medicine INMD 981 Rheumatology Internal Medicine INMD 982 Hematology/Oncology Internal Medicine INMD 984 Nephrology Internal Medicine INMD 985 Infectious Disease Internal Medicine INMD 986 Physical Medicine and Rehab Internal Medicine INMD 987 Neurology Internal Medicine INMD 988 Gastroenterology Internal Medicine INMD 989 Dermatology Internal Medicine INMD 991 Cardiology Internal Medicine INMD 994 Ambulatory Care in Int Med Internal Medicine INMD 995 Special Topics:Int Med Internal Medicine INMD 998 Internal Medicine Subinternship Internal Medicine RLMD 977 Rural Medicine:Internal Medicine OB/GYN OBGN 976 Gen Obstetrics and Gynecology OB/GYN OBGN 977 Maternal--Fetal Medicine OB/GYN OBGN 979 Gynecologic Oncology OB/GYN OBGN 995 Special Topics:Ob-Gyn OB/GYN OBGN 998 Obstetrics-Gynecology Subinternship Ophthalmology OTHO 976 Ophthalmology Pathology PALO 976 Intro to Clin Pathology--St. Joseph Pathology PALO 977 Laboratory Medicine Pathology PALO 978 Intro to Surgical Pathology Pathology PALO 979 Intro to Clin Pathology--Wesley Pathology PALO 980 Intro to Forensic Pathology Pediatrics CCSL 977 Critical Care Sel:Neonatology Pediatrics CCSL 979 Critical Care Sel:Pediatrics Pediatrics PDRC 976 General Pediatrics Pediatrics PDRC 977 Neonatology Pediatrics PDRC 978 Ambulatory Pediatrics Pediatrics PDRC 979 Medical Genetics Pediatrics PDRC 980 Pediatric Endocrinology Pediatrics PDRC 981 Diabetes Pediatrics PDRC 982 Pediatric Hematology/Oncology Pediatrics PDRC 983 Pediatric Critical Care Pediatrics PDRC 984 Pediatric Allergy Pediatrics PDRC 985 Pediatric Cardiology Pediatrics PDRC 986 Pediatric Neurology Pediatrics PDRC 987 Developmental Pediatrics Pediatrics PDRC 988 Pediatric Infectious Disease Pediatrics PDRC 995 Special Topics:Pediatrics Pediatrics PDRC 998 Pediatric Subinternship Pediatrics RLMD 978 Rural Medicine:Pediatrics Preventive Medicine PVMD 975 Health of the Public Preventive Medicine PVMD 995 Special Topics in Preventive Med Psychiatry PSCR 978 Child/Adolescent Psychiatry Psychiatry PSCR 979 Advanced Studies in Psychiatry Psychiatry PSCR 980 Geriatric Psychiatry Psychiatry PSCR 981 Consultation/Liaison Psychiatry Psychiatry PSCR 983 Clinical Addictionology Psychiatry PSCR 985 Clinical Psychopharmacology Psychiatry PSCR 987 Outpatient Psychiatry Psychiatry PSCR 995 Special Topics:Psych Psychiatry PSCR 998 Psychiatry Subinternship Radiology RAD 976 Radiology Radiology RAD 995 Special Topics:Radiology Research MDRS 976 Medical Research Special Program CCSL 999 Critical Care: Off-Campus Special Program SPCP 976 Spec Prog:Dom Off-Campus Special Program SPCP 977 Spec Prog: International Special Program SPCP 978 Spec Prog: On-Campus Special Program SPCP 998 Spec Prog:Subinternship Surgery CCSL 980 Critical Care Sel:Burn Surgery CCSL 983 Critical Care Sel:Trauma Surgery SGRY 972 Urologic Surgery Surgery SGRY 977 Plastic Surgery Surgery SGRY 978 Orthopedic Surgery Surgery SGRY 979 Cardiothoracic Surgery Surgery SGRY 980 Burn and Critical Care Surgery SGRY 981 Neurosurgery Surgery SGRY 983 General Surgery Preceptorial Surgery SGRY 985 Pediatric Surgery Surgery SGRY 986 Peripheral Vascular Surgery Surgery SGRY 987 Senior Elective in Surgery Surgery SGRY 995 Special Topics:Surg Surgery SGRY 997 Sports Medicine Surgery SGRY 998 Surgery Subinternship
Date Request:
2.Course Request:
Explanation:
This form is a pre-enrollment request that we hope to accommodate. It does not replace your attendance at the enrollment session in April. If you will be out of town the day of enrollment, you must contact Academic & Student Affairs prior to the enrollment session. Please submit this Pre-Enrollment Request by 5:00 PM, April 4, 2008.
(Your request will be sent to Melanie Runge via e-mail. You may print off the confirmation page for your records)
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