Name:* First Last Email:* Enter Email Confirm Email What specialty are you interested in applying to for residency?*Block 1 to 3: (Please, keep in mind that the first three blocks are recommended for Audition Rotations, or Clinical Rotations from which you may request Letters of Recommendations (LORs)).Block 1: Please enter planned specialty, or “Study Month”Location:AwayIn-RACBlock 2: Please enter planned specialty, or “Study Month”Location:AwayIn-RACBlock 3: Please enter planned specialty, or “Study Month”Location:AwayIn-RACHiddenBlock 4: Please enter planned specialtyHiddenLocation:AwayIn-RACEmergency Medicine (EM) Selective*Do you plan to take a selective EM Rotation in the RACs? If yes, please, select the block that you plan to have your selective EM Rotation in. By selecting yes, this does not guarantee placement in assigned RAC. Yes No Option I: Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 Option II: Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 If no, please select block you plan on taking EM Selective away. Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Selective ICU*Do you plan to take a Selective ICU Rotation in the RACs? If yes, please, select the block that you plan to have your Selective ICU Rotation in. By selecting yes, this does not guarantee placement in assigned RAC. Yes No Option I: Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 Option II: Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 If no, please select block you plan on taking ICU Selective away. Block 1 Block 2 Block 3 Block 4 Block 5 Block 6 Block 7 Block 8 Block 9 Block 10 Block 4 to 10: (Please, keep in mind November through January are interview months (Block 5 to 7))Block 4:AwayIn-RACBlock 5:AwayIn-RACBlock 6:AwayIn-RACBlock 7:AwayIn-RACBlock 8:AwayIn-RACBlock 9:AwayIn-RACBlock 10:AwayIn-RACRAC Assigned During Year 3:*Albuquerque, NMEastern New Mexico, NMEl Paso, TXLas Cruces, NMSpace Coast, FLTucson, AZFour Corners, NMPlease, select the specialties that you are interested in:* Addiction Psychiatry Allergy and Immunology Anesthesiology Cardiovascular Disease Dermatology Emergency Medicine Endocrinology Diabetes and Metabolism Family Medicine Gastroenterology General Surgery Hematology and Oncology Hospice and Palliative Medicine Internal Medicine Medical Oncology Neonatal-Perinatal Medicine Nephrology Neurological Surgery Neurology Neuromuscular Medicine and OMT Obstetrics and Gynecology Oncology Ophthalmology Orthopaedic Surgery Otolaryngology Pain Medicine Pathology Pediatric Surgery Pediatrics Physiatry Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Radiation Oncology Radiology Rheumatology Surgical Oncology Urology *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RACPlease, select the specialties that you are interested in:* Anesthesiology Cardiology Cardiovascular Disease Dermatology Emergency Medicine Endocrinology Diabetes and Metabolism Family Medicine Gastroenterology General Surgery Hematology and Oncology Internal Medicine Nephrology Neuromuscular Medicine Neurology Obstetrics and Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pediatrics Psychiatry Rheumatology Urology *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RACPlease, select the specialties that you are interested in:* Anesthesiology Cardiovascular Disease Child Neurology Critical Care Medicine Dermatology Emergency Medicine Endocrinology Diabetes and Metabolism Family Medicine Foot and Ankle Orthopaedics Gastroenterology General Surgery Hand Surgery Hematology Infectious Disease Internal Medicine Interventional Cardiology Neonatal-Perinatal Medicine Nephrology Neurological Surgery Neurology Neuromuscular Medicine Physical Medicine and Rehabilitation Obstetrics and Gynecology Oncology Ophthalmic Plastic and Reconstructive Surgery Ophthalmology Orthopaedic Sports Medicine Orthopaedic Surgery Pain Medicine Pathology Pediatric Gastroenterology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Pulmonary Disease Pulmonary Disease and Critical Care Medicine Radiation Oncology Radiology Rheumatology Urology *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RACPlease, select the specialties that you are interested in:* Anesthesiology Cardiovascular Disease Critical Care Medicine Emergency Medicine Family Medicine General Surgery Hematology and Oncology Internal Medicine Nephrology Neurological Surgery Obstetrics and Gynecology Ophthalmology Orthopaedic Surgery Otolaryngology Pain Medicine Pediatrics Psychiatry Vascular and Interventional Radiology *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RACPlease, select the specialties that you are interested in:* Anesthesiology Cardiology Cardiovascular Disease Emergency Medicine Endocrinology Diabetes and Metabolism Family Medicine Gastroenterology General Surgery Hematology and Oncology Hospice and Palliative Medicine Infectious Disease Internal Medicine Nephrology Neurology Neuromuscular Medicine and OMT Obstetrics and Gynecology Occupational and Environmental Medicine Ophthalmology Orthopaedic Surgery Orthopaedic Surgery of the Spine Pathology Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Pulmonary Disease and Critical Care Medicine Radiology Rheumatology Thoracic Surgery Urology Vascular Surgery *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RACPlease, select the specialties that you are interested in:* Anesthesiology Cardiology Cardiovascular Disease Child and Adolescent Psychiatry Clinical Cardiac Electrophysiology Colon and Rectal Surgery Critical Care Medicine Dermatology Dermatopathology Emergency Medicine Endocrinology Diabetes and Metabolism Family Medicine Forensic Psychiatry Gastroenterology General Surgery Geriatric Medicine Hand Surgery Hematology and Oncology Hospice and Palliative Medicine Infectious Disease Internal Medicine Interventional Cardiology Nephrology Neurology Neuromuscular Medicine and OMT Obstetrics and Gynecology Oncology Ophthalmology Orthopaedic Surgery Otolaryngology Pain Medicine Pathology Pediatrics Physical Medicine and Rehabilitation Psychiatry Pulmonary Disease and Critical Care Medicine Radiology Reproductive Endocrinology Thoracic Surgery Urology Vascular Surgery *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RACPlease, select the specialties that you are interested in:* Allergy and Immunology Anesthesiology Bariatric Surgery Cardiology Cardiovascular Disease Critical Care Medicine Emergency Medicine Family Medicine Gastroenterology General Surgery Hematology and Oncology Infectious Disease Internal Medicine Medical Oncology Neonatal-Perinatal Medicine Nephrology Neurological Surgery Neurology Neuromuscular Medicine and OMT Obstetrics and Gynecology Oncology Ophthalmic Plastic and Reconstructive Surgery Orthopaedic Surgery Otolaryngology Pathology Pediatric Critical Care Medicine Pediatric Emergency Medicine Pediatric Infectious Diseases Pediatric Sports Medicine Pediatrics Physical Medicine and Rehabilitation Plastic Surgery Psychiatry Pulmonary Disease and Critical Care Medicine Radiology Rheumatology Urology Vascular Surgery *Please, select all that apply **Disclaimer: Submitting this form does not guarantee the specialty in the RAC ***ICU Selective Specialty is not guaranteed in RAC Δ