UTSW Neurosurgery Observership Program

Please submit this form if you are interested in observing in the Department of Neurological Surgery at UT Southwestern Medical Center.

Want your application expedited?

If you would like your application processed faster, please email your immunization records to brianna.morales@utsouthwestern.edu upon completion of this survey.

Thank you,

Question Title

* 1. First and Last Name

Question Title

* 2. Email Address

Question Title

* 3. Who has agreed to host you? (NOTE: You are responsible for finding a host to shadow)

Question Title

* 4. Please upload a letter or email from your host stating their approval for you to shadow them.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Question Title

* 5. When is your planned start date? (This MUST be at least 4 weeks from today)

Start Date

Date

Question Title

* 6. Please attach your current resume/CV

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Question Title

* 7. Select the one that best fits you.

High School

Undergraduate

Medical Student

Resident/Fellow

International Applicant

Advanced Practice Practitioner

UTSW Employee

Family Member of UTSW Employee

Other