Details

PLEASE NOTE YOU SHOULD ONLY SUBMIT THIS FORM AFTER YOU HAVE REGISTERED FOR THE INTERACTIVE RADIOLOGY ELECTIVE WITH THE RWJMS Registrar.

If you have been recently notified of being registered for the Interactive Radiology Elective, please complete the following form AS SOON AS POSSIBLE.

RWJMS Radiology Department

Please review the elective overview here at your earliest convenience before starting the elective. Please note that completing this registration form is required prior to the start of your elective.

Elective Registration Form

Have you received notice from the RWJMS registrar you are registered for this elective?

Name:

Preferred Email Address?

Elective Dates?

Number of Weeks of Elective?

What operating system do you primarily use?

Do you have a laptop you can use during the rotation?

Do you have a USB drive you can use during the rotation?

Any comments / requests/ questions you would like to include.