ILMA advisory form

Full Name

Medical School

I am currently a:

I graduated/will graduate in (provide the year):

Field of interest (i.e., internal medicine, surgery…)

I am interested in getting help with (select all that apply):

If applying to residency, provide the anticipated year of applying to the Match

If applying for an elective or fellowship, provide the anticipated month/year and the desired specialty

STEP exams completed

Provide us with your email

Provide us with your phone number (optional)

Would you like to be contacted by ILMA members for further assistance

Are you ECFMG certified?

What is your nationality?

Do you hold any additional nationality?

If yes, please specify your second nationality:

Are you a US citizen or greencard holder? (This is usually helpful for electives, research opportunities…):

Previous research experience if applicable :

Number of publications if applicable :

Previous electives/observerships in the US. If yes, the name of the program and specialty: