Name : / **Nickname: / Date:
E-mail: / PID: / Phone:
· Required blocks: One UCF 4-week block (One AI of your choice)
· No more than 4 required electives may be in the same specialty
· Students may choose to take up to 3 months or 12 weeks for studying, residency interviews and/or vacation
· Additional AI’s may be taken as electives (limited space available in some AIs).
· List a Primary and Alternate course for each block, indicate UCF location or Away, include any special instructions.
· *Student Affairs recommends all students stay in the Orlando area during March in case they have issues with “The MATCH”
Note: Students are expected to discuss their 4th year with their Academy Leader.
Academy Leader, Dr. ______Signed: ______Date: ______Approved: ___
Student Signature: ______Date: ______Anticipated Specialty(s) ______
Primary Choice / Alternate Choice / Primary Choice - Special Instructions*
Block/Date / Course / Location / Course / Location / ?IS, MH, AE, VSAS?
Block 1
June 6 – July 1, 2016
Block 2
July 4 –July 29, 2016
Block 3
Aug 1 – Aug 26, 2016
Block 4
Aug 29 – Sep 23, 2016
Block 5
Sep 26 – Oct 21, 2016
Block 6
Oct. 24 – Nov 18, 2016
Block 7
Nov. 21 – Dec. 16, 2016
Residency Interviews/ Break December 17, 2016 – January 8, 2017
Block 8
Jan 9 – Feb 3, 2017
Block 9
Feb 6- Mar 3, 2017
*Block 10 (MATCH)
Mar 6 – Mar 31, 2017
Block 11
Apr 3 – Apr 28, 2017
CAPSTONE (REQUIRED) May 1 -5, 2017 / *Graduation May 19, 2017*
· Special instructions: Intended Specialty (IS); Must have this block (MH), Hold for Away Elective (AE), Applying via VSAS (VSAS