APPLYING FOR ELECTIVES

INSTRUCTIONS:

1. Incomplete application packets will not be processed by SUSOM. You will be

notified by email that it is not complete and you need to resubmit the entire packet.

2. You must find and apply for electives at least 8 weeks prior to the start date.

3. Complete the Elective Planning and Request forms found on sabamed.org.

Sabamed.org > Elective Clerkship Scheduling > Elective Planning and Request Forms.

4. In addition, if you are applying to Wyckoff Heights Medical Center, complete the
Application for Wyckoff Heights Medical Center (Page 7).

5. You must confirm the ACGME/AOA (Green book) status of your electives.
a. US site accreditation status can be verified using the following resources:
i. FREIDA Online American Medical Association Residency & Fellowship
Database. http://www.ama-assn.org/ama/pub/education-careers/graduate-
medical-education/freida-online.page.
ii. Accreditation Council for Graduate Medical Education (ACGME).
www.acgme.org.
iii. American Osteopathic Association approved post-graduate training.
http://opportunities.osteopathic.org/search/search.cfm?searchType=1.
b. Canadian sites must be affiliated to a Canadian Medical School.
c. For additional information, refer to Part 4: Fourth Year Rotations in the Clinical
Medicine Handbook.

6. Submit all forms in one email to your assigned Clinical Assistant.

a. Clinical Assistants by your last name:
A - H = Kristen Levine (k.levine@saba.edu)
I - N = Beth Keene (b.keene@saba.edu)
O - Z = Marion Strait (m.strait@saba.edu)
b. In the subject line of the email you must specify the reason for your email.
i. Examples
1. If you are requesting an elective, your subject line should be
written as follows: Elective Site Elective Name Dates
Requested.
2. If you are notifying your assigned Clinical Assistant of an elective
given to you by a site at which you may be rotating already, your
subject line should be written as follows: Elective Approved for
Dates

7. SUSOM will send paperwork to the elective site on your behalf.

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 a) If there is a specific application form from the site, you must send it with the
Elective Planning Form & Elective Request Form to your assigned Clinical
Assistant. If the site application form is a hard copy, you must mail it with all
supporting documents (photograph, application fee, etc.) to your assigned Clinical
Assistant. Even if you complete a sites online application for an elective
clerkship, you must still submit the Elective Planning Form & Elective Request
Form to your assigned Clinical Assistant.

8. If your application requires a Letter of Good Standing, SUSOM will process and send
this with the application. You do not need to call/email to request this.

9. You will receive an email from the elective site as to whether or not the elective is
approved by the site. You must then forward this email to your assigned Clinical
Assistant.

10. You will be notified by your assigned Clinical Assistant if you have received final
approval by SUSOM for the elective clerkship.

IMPORTANT GENERAL INFORMATION

If all of the above steps have not been completed, you will not receive credit for the clerkship
and you will be charged the applicable fees.
Please double check all of your clerkship dates, names, and weeks scheduled on sabamed.org.
You must cancel electives at least 30 days prior to the start date or you will
be charged for the entire elective.

CANADIAN ELECTIVES
You must first submit your Elective Planning Form & Elective Request Form to your assigned
Clinical Assistant.
Then, complete the online application for the Canadian Portal
(https://www.afmcstudentportal.ca/ ).
If the individual site requires a paper application, you must mail it with all supporting documents
to your assigned Clinical Assistant.

FEES:
Students are responsible for all weekly charges above $200 per week, including for Family
Medicine.
You are responsible for all application fees. However, rotation fees may be reimbursed.
For affiliated sites, Saba will pay the weekly fee, and bill the student for any charges over
$200
per week.
For non-affiliated sites, the student pays the weekly fee in advance. For reimbursement,
Saba
must receive the preceptor evaluation and proof of payment.
The Saba University Finance Department will send the student a billing statement
showing any
fees the student owes. This payment will be due 30 days after receipt of invoice.

ELECTIVE SELECTION:
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The thirty (30) weeks of electives must include clerkships that meet each of the following
criteria.

Primary Care: One four (4) week Primary Care Elective (e.g., Family Medicine,
Ambulatory Internal Medicine or Ambulatory Pediatrics)
Internal Medicine or Pediatrics Sub-Specialty: One four (4) week Internal Medicine
or Pediatrics Sub-Specialty elective, in recognized sub-specialties.
Acute Care: One four (4) week clerkship (e.g. Emergency Medicine, Urgent Care, or
on a case by case basis clerkships with evaluation of only acutely presenting patients
(undifferentiated) in a specialty).
Sub-Internship/Acting Internship: One four (4) week sub-internship or acting
internship in Internal Medicine, Pediatrics, Surgery or Obstetrics/Gynecology. For
Family Medicine and Psychiatry, a sub-internship may be approved on a case by case
basis.

A sub-internship clerkship does not substitute for the acute care or the sub-specialty
clerkship requirement.

Two week electives are acceptable for other than the required electives. Electives longer
than four (4) weeks duration are considered by the Office of the Associate Dean of
Clinical Medicine on a case-by-case basis.

A list of all of the electives (in the U.S. and Canada) completed by Saba students in the last few
years is available on sabamed.org in the following location:

Sabamed.org > Elective Clerkship Scheduling > Saba Elective Experience.

Lists of common Surgery & Internal Medicine subspecialties can be found in the following
locations:

Sabamed.org > Elective Clerkship Scheduling > Suitable Surgical Subspecialties.

Sabamed.org > Elective Clerkship Scheduling > Suitable Internal Medicine
Subspecialties.

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 SABA UNIVERSITY SCHOOL OF MEDICINE
ELECTIVE REQUEST FORM

Are you US Citizen/Permanent Resident? Yes No

Student Name: Date Submitted:

E-mail: Cell Phone Canada:
US:

Step 1 Score: Step 2 CK Score: Not Taken

Step 2 CS: Pass Fail Not Taken

Taking into consideration your Step Scores, what type of residency are you aiming for?

Primary Care Specialty ( Internal Medicine, Family Medicine, Pediatrics)

Secondary Care Specialty (e.g. Radiology, Anesthesiology, Dermatology, Surgery, etc.):

Choose one of the following:

I have included the University or Hospital/Clinical Site Application with this form.
This site has an Online Application.
This site requires an original application, which I mailed to SUSOM on (Date)
I have not yet submitted my application to SUSOM Clinical Office.
Explain briefly:

Clerkship Information:
Elective Clerkship: ____________________ Department: ____________________
Dates of Clerkship: # of Weeks:
Hospital:
University Affiliation: No Affiliation
Hospital Address:
Hospital Phone Number:
Medical Education Contact Person:
Phone Number:_____________ Email Address:
Preceptor Name:
Hospital ACGME/Greenbook Status: Family Practice Umbrella Per Specialty Unknown
ACGME #
Is there a clerkship fee? Yes No $
Is there an application fee? Yes No $ (Students responsibility.)

* Students are responsible for all weekly charges above $200 per week.
 SABA UNIVERSITY SCHOOL OF MEDICINE
ELECTIVE PLANNING FORM
Name: Date:
Anticipated Grad Date

Please review: Getting Started with Electives Go to My Saba>Electives>Getting Started with Electives

Score
USMLE Step 1 Anticipated Date:
Step 2 CK Not yet Taken
Step 2 CS P F Not yet Taken

I am interested in the following Residencies:

1.
2.
3.

Elective Outline
List all of your Electives (Completed and Planned)
Check if Saba has already approved the elective and/or the rotation has been completed.
Elective categories in bold are required for all students. Saba
An elective in Neurology is strongly encouraged. Use
Only

Ok to
Hospital/Clinical Saba Prior Dates
Electives Completed #weeks proceed
Site Approved (mm/dd/yyyy)
Y/N
Primary Care From:
Family Medicine
1. Ambulatory IM
Ambulatory To:
Pediatric
Sub-specialty(choose From:
one)
Internal Medicine
- Sub-specialty:
2.

To:
Pediatrics
- Sub-specialty:

From:
Acute Care

Emergency
3.
Medicine
To:
Urgent Care
Other

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 From:
Sub-Internship

Internal Medicine
Surgery
4.
Pediatrics
To:
Ob/Gyn
Family Medicine*
Other*
From:
5.
To:
From:
6.
To:
From:
7.
To:
From:
8.
To:
From:
9.
To:
From:
10.
To:
From:
11.
To:
From:
12.
To:

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 SABA UNIVERSITYS APPLICATION FOR WYCKOFF HEIGHTS ELECTIVES

Along with the Elective Planning Form, and the Elective Request Form, you must send this completed form to
your assigned Clinical Assistant. Saba will forward your application to Wyckoff Heights Medical Center.

* Any changes to your scheduled Wyckoff electives must be made at least 2 weeks prior to start date.
* Any cancellations must be made at least 30 days prior to the start date or you may be charged for the entire
elective.
* All cancellations must be made through the Saba Clinical Assistant, and not directly with Wyckoff.

Student Name: Date Submitted:

E-mail: Cell Phone US: Canada:

Step 1 Score Step 2 CK Score Not Taken

Step 2 CS Pass Fail Not taken

Clerkship Information:

Elective Clerkship: Department:

Dates: # of Weeks

Elective Clerkship: Department:

Dates: # of Weeks

Elective Clerkship: Department:

Dates: # of Weeks

Available Wyckoff Heights Electives

Adult ER Hem/Onc Pathology

Ambulatory Medicine Infectious Disease Pediatric ER
Anesthesiology Internal Medicine Sub-I Pediatric Sub-I
Cardiology Nephrology PM&R
Emergency Medicine Neurosurgery (Surgery Elective) Surgery Electives (Orthopedic,
Endocrinology NICU (Pediatric Elective) Otolaryngology/ ENT,
Ophthalmology, Neurosurgery,
Gastroenterology OB/GYN Sub-I
Surgery Sub-I, Surgical ICU)
GYN Surgery (OB Elective) Pain Management Pulmonary ICU

Please Note:
All Wyckoff electives start the 1st Monday of each month and are 4-weeks in length.
Medical Students must schedule Wyckoff electives through their medical school offices.
When you receive your email confirmation from Wyckoff, you must forward this email to your
assigned Clinical Assistant.
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