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Please complete the following
VEPSUM Fellowship
Form. The items marked with asterisk (*) are required.
Introduction
Thank you for your interest in VEPSUM!
Sponsored by the Icahn School of Medicine at Mount Sinai's Center for Multicultural and Community Affairs, VEPSUM Fellowship offers four-week electives at The Mount Sinai Hospital to a limited number of qualified 4th-year medical students who attend United States accredited medical schools, and who are from groups underrepresented in medicine.
For the purposes of this program, groups underrepresented in medicine are defined as Hispanic (Mexican, Chicano, or Mainland Puerto Rican), Other Hispanic (Cuban, Dominican, or other), Black/African-American (not of Hispanic origin), Native American or Asian Pacific Islander. VEPSUM Fellowship is designed to increase diversity in the house staff and subsequently the faculty of the Icahn School of Medicine at Mount Sinai and its affiliated institutions, by helping talented minority medical students gain access to electives in our programs.
The total number of accepted VEPSUM students is contingent upon available funding and placement capacity. VEPSUM is a competitive program and placements will not be offered to all applicants.
All supplemental materials must be uploaded OR emailed to VEPSUM@mssm.edu.
Please refer to our website for further information: Icahn.mssm.edu/vepsum
Eligibility Information
*
1. Do you attend an AAMC-accredited Medical Degree (allopathic) medical school?
-- select --
Yes
No
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2. Do you attend osteopathic medical schools (i.e., are enrolled in Doctor of Osteopathy-granting programs)?
-- select --
Yes
No
*
3. Do you attend a non-US-based medical school, or are you currently enrolled in or graduated from a non-US medical school?
-- select --
Yes
No
VEPSUM Application
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3. Legal Name
*
4. Preferred Name
*
5. Name of Medical School
*
6. School Mailing Address
*
7. School City
*
8. School State
*
9. School Zipcode
*
10. Permanent Address
*
11. Permanent City
*
12. Permanent State
*
13. Permanent Zipcode
*
14. Phone (preferred)
*
15. Date of Birth (M/D/Y)
*
16. Preferred E-mail
*
17. Citizenship Status
-- select --
Permanent Resident
U.S. Citizen
*
18. I am currently a
-- select --
3rd Year Student
4th Year Student
On scholarly leave
If you are on scholarly leave, please explain
*
19. Gender
-- select --
Male
Female
Transgender
*
20. What is your ethnicity
-- select --
Hispanic or Latino
Not Hispanic or Latino
*
21. What is your race
-- select --
American Indian or Alaska Native
Asian - Not Underrepresented
Asian - Underrepresented (any group other than Chinese, Filipino, Japanese, Korean, Indian or Thai)
Black or African American
Native Hawaiian or Other Pacific Islander
White
*
22. Elective Choice: In what specialty would you like to attend an elective
-- select --
Anesthesiology
Dermatology
Emergency Medicine
Family Medicine
Internal Medicine
Internal Medicine-Pediatrics (MedPeds)
Neurological Surgery
Neurology
Obstetrics & Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Pathology
Pediatrics
Physical & Rehabilitation Medicine
Plastic Surgery
Psychiatry
Radiation Oncology
Radiology
Surgery
Urology
23. ELECTIVE DATE RANKING: Please complete your preferences for elective time frames below. Please provide suggested time frames for your preferred elective choices, to take place between the months of August and October of your 4th year of medical school. (for example, acceptable formats include: "the month of October" or "from August 15 - September 15th") Please also list your suggested dates in order or preference:
*
First Choice
Second Choice
Third Choice
*
24. Housing: Will you require housing
-- select --
Yes
No
25. APPLICATION AGREEMENT: In order to COMPLETE my VEPSUM application, I agree to send the following application materials. I understand that my application will be considered INCOMPLETE and will not be reviewed if these materials are not sent. I acknowledge that under no circumstances will paper application materials be accepted.
Please note: You have the option of uploading materials with this form OR emailing them to vepsum@mssm.edu.
*
I understand and agree to upload or send the materials to vepsum@mssm.edu with my NAME in the email SUBJECT line
-- select --
Yes
No
Required Application Materials
Please submit the following materials:
Application
Please upload or send via email attachment to VEPSUM@mssm.edu with the applicant’s full name in the subject line:
CV/Resume
Unofficial medical school transcript (Please note that students must have completed their required core clerkships before starting the program. A completed transcript with grades from these clerkships is necessary for a complete application)
USMLE Step 1 score and USMLE Step 2 scores if available
One letter of recommendation from a Dean at your home institution
One letter of recommendation from a faculty member at your home institution who is in the specialty to which you are applying for in VEPSUM
Recent Photo
If accepted into VEPSUM, students will need to apply through the Visiting Student Learning Opportunities (VSLO) system. This should be done only AFTER the students have been notified by VEPSUM of their acceptance. VEPSUM will not cover any fees associated with the VSLO process or pre-elective clearance such as specific medical screenings or clearance required for eligibility to rotate as a visiting student.
Please note: If you are applying to VEPSUM, do not contact the clinical departments or the Office of Student Affairs to coordinate the desired elective.
E-mail all of the above application materials to vepsum@mssm.edu
Applications that are sent only through the Visiting Student Learning Opportunities and not through the above procedure will not be considered for allocated funding or elective placements available through VEPSUM. We look forward to receiving your application.
PROGRAM CONTACT INFORMATION
QUESTIONS ABOUT ELECTIVE SELECTION, PLACEMENT AND APPLICATION STATUS:
Sherria McDowell, MPH
Director of Special Programs
Email: Sherria.McDowell@mssm.edu
Center for Multicultural & Community Affairs
Gary C. Butts, MD
Executive Vice President for Diversity, Equity and Inclusion, Mount Sinai Health System
Chief Diversity and Inclusion Officer and Director, Office for Diversity and Inclusion, Mount Sinai Health System
Dean for Diversity Programs, Policy, and Community Affairs
Director, Center for Multicultural and Community Affairs
Email: gary.butts@mssm.edu
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