PGY-2 Selective Request Form
PGY-2s: Use this form to indicate your SELECTIVE choice

Submission deadline (non-negotiable): 30 days prior to start date
*failure to adhere to this deadline may result in your selective being scheduled as an EM block

Please consult the Resident Handbook for information about each Selective option, such as learning objectives, schedule, etc.
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My Name: *
I'm Scheduling: *
Block and Dates of Selective *
My Selective choice is: *
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