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Physician Assistant Student rotations may be available for PA students in programs that have an affiliation agreement with Riverside. Contact your university or Riverside’s GME Clinical Student Coordinator to check on current affiliation status. PA students may rotate with a physician or PA.

To apply for a rotation please complete the Graduate Clinical Student Rotation Application below.

An Affiliation Agreement between your medical school and Riverside Medical Center must be fully executed and on file before a rotation may be offered. If we are not currently affiliated with your school, please have your school contact the Graduate Medical Education Clinical Student Coordinator at 815-935-7256 Ext. 6156. Allow 90 days to arrange an affiliation agreement.

Please complete the Rotation Application below, which will be submitted the Graduate Medical Education Clinical Student Coordinator. You will be notifited by email if your requested rotation is available. It will be your responsibility to notify your school and have all requested documents sent to the Graduate Medical Education Department.

Full Name:
First   Last
Gender:
E-mail Adress:
Home Address:
City   State   Zip
Phone: -
Current School:
Name of Degree:
Request Start Date for Clinical Hours:
Expected Graduation Date:
Are You a Current Employee of Riverside Heathcare:
Yes    No
If Yes, in Which Department Do You Work:
If No, Have You Ever Been Employed By Riverside:
 
Clinical Faculty/Professor Contact Information: Please provide the contact information for the clinical faculty/professor/coordinator from your school who will serve as the contact during your practicum:
Name:
Title/Position:
Phone:
Eamil:
 
Rotation Request 1:
Other Rotation:
Hours or Month:
Anticipated Start Date:
month   day   year
Anticipated End Date:
month   day   year
Additional Notes:
 
Rotation Request 2:
Other Rotation:
Hours or Month:
Anticipated Start Date:
month   day   year
Anticipated End Date:
month   day   year
Additional Notes:
 
Rotation Request 3:
Other Rotation:
Hours or Month:
Anticipated Start Date:
month   day   year
Anticipated End Date:
month   day   year
Additional Notes: