Usmle sponsorship questionnaire



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tarix14.06.2018
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#48509

GRADUATION QUESTIONNAIRE

Name:
Semester;
Current Cell phone:
Current Email:
Last Date of attendance of 5th semester:
Last Date of attendance of final semester:

What courses have you taken for USMLE after 5th semester:

(e.g.: Kaplan, Faulkon, Pass program etc)
What courses have you taken for USMLE after final semester:

(e.g.: Kaplan, Faulkon, Pass program etc)

How long have you taken time off after completing the 5th semester to prepare for USMLE:
How long have you taken time off after completing the final semester to prepare for USMLE:

When was the first time you have applied for USMLE step-1:
When was the first time you have applied for USMLE step-2:

When was the last time you have applied for USMLE step-1:
When was the last time you have applied for USMLE step-2:

How many times you have taken USMLE step-1:

How many times you have taken USMLE step-2:
Mention the scores that you have obtained in USMLE step-1:
First time:________ Second time:_______ Third time:_______
Any additional times_____________________________
Mention the scores that you have obtained in USMLE step-2:
First time:________ Second time:_______ Third time:_______
Any additional times_____________________________


I want my USMLE application form and graduation from Windsor University to be sent for processing. I will fax my USMLE step-1 and step-2 score report to 708-235-1942 immediately. I understand that failing to fax the score report both front and back pages would delay my Official USMLE form and graduation to be processed by the school.
I also understand that failing the USMLE step-1 and 2 next time would make it mandatory to take a intensive MARATHON USMLE STEP-1 and 2 REVIEW ( 15 DAYS COURSE ) FOR RETAKING THE EXAM.
I also understand that I will be required to have a faculty advise on USMLE preparatory exam and my academics.

Name:
Signature
Date:
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