Rotation Application InstagramThis field is for validation purposes and should be left unchanged.First Name(Required)Middle Initial(Required)Last Name(Required)Email(Required) Cell Phone Number(Required)State of Residence(Required)County(Required)Medical School(Required)City (Medical School)(Required)State (Medical School)(Required)Current Medical School Level(Required)If other, please specifyGraduation Date(Required) MM slash DD slash YYYY My Medical School has a Clinical Affiliation Agreement in place with DeTar Health Care(Required) Yes No Provide first choice of dates for your rotation(Required)Provide second choice of dates for your rotation(Required)Provide third choice of dates for your rotation(Required)Provide fourth choice of dates for your rotation(Required)Questions/Comments(Please provide any additional information that will assist us in coordinating your rotation)CAPTCHA
