Enrollment request for Health of the Public, offered in November of 2009, and February and April of 2010 (you must indicate your preferences at this time for all of fourth year, otherwise we will schedule you where we have openings – see dates below). Please enter your preference of offerings, 1- 3 with 1 being your first choice.
Early enrollment request for a maximum of two rotations you feel are very important for you in planning your future career. You may be choosing:
- specific course/1st choice of several possible dates
- specific dates/1st choice of several possible courses
- specific course/specific dates

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. Clarify or expand on your choices in the “Explanation” section, such as an event you are planning around, or why this is important to you. Include other months or courses that would also be acceptable. Also, use “Or/And” to clarify your choices. 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 or e-mail your request to: mrunge@kumc.edu

Rural Preceptorships are arranged through either Family Medicine, Internal Medicine, or Pediatrics departments. To schedule your rural preceptorship: 1) go to department, 2) work out details, and, 3) complete an add slip. Special arrangements are necessary for away electives, “Special Programs” (talk to Melanie in ASA). Do not request your rural preceptorship or away electives on this form.

*Required Fields

KU Med Catalog

*First Name:
*Last Name:

Senior requirement Health of the Public: you must rank month offerings in order of preference:
First Choice:
Second Choice:
Third Choice:

Other Course Offerings for Fall 2009 only:
1.Course Request:	(Department / Course Number / Course Name)
Date Request:

	Or And

2.Course Request:	(Department / Course Number / Course Name)
Date 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, March 19, 2009.

(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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