SoM Summer Elective Applications 2020_NUIG Students

School of Medicine/Galway University Hospital - 2020 Summer Elective Programe (SoM Students)

Name*

First Name

Last Name

ID Number*

Year of Study*

Programme open to 4MB students only

NUIG Email Address*

Mobile Number*

Please select preferred discipline*

Medicine Surgery

If you selected Medicine above, please select your preferred Elective in rank order (1 = most preferred option, 7 = least preferred option)

Emergency

Neurology

Limited availability

Cardiology

Endocrinology

Nephrology

Oncology

Respiratory

If you selected Surgery above, please select your preferred Elective in rank order (1 most preferred option, 5, least preferred option)

Cardiothoracic Surgery

General Surgery

Orthopaedic Surgery

Plastic Surgery

Vascular Surgery

Summer Elective Programme Duration*

4 Weeks 8 Weeks

Please select if you would like to undertake a 4 week or an 8 week Elective

Summer Elective Programme Dates (4 Week Programme)

Not applying for 4 week programme Tuesday, 2nd June - Friday, 26th June (inclusive). (Monday 1st - Bank holiday) Monday, 29th June - Friday, 24th July (inclusive) Monday, 27th July - Friday, 21st August (inclusive)

Based on your selection above (i.e. 4 or 8 weeks), please select your date preference to undertake your Elective

Summer Elective Programme Dates (8 Week Programme)

Not applying for 8 week programme Tuesday, 2nd June - Friday, 24th July (inclusive) (Monday 1st, Bank Holiday) Monday, 29th June - Friday, 21st, August (inclusive)

Based on your selection above (i.e. 4 or 8 weeks), please select your date preference to undertake your Elective