CHECKLIST OF ITEMS TO BE INCLUDED IN APPLICATION PACKET

ALL INFORMATION MUST BE PROVIDED IN ENGLISH

APPLICATION PACKET MUST BE RECEIVED NO LESS THAT THREE (3)MONTHS
BEFORE YOU WISH TO STUDY AT THE UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE

Completed application forms

Letter of credentials from parent school. Letter must include the following information:
Indicate that you are currently registered and in good standing at your school;
Statement on your professional behavior;
You will be a FINAL year student at the time of your participation in the United States;
Will be granted credit at your home school for this elective;
Have passed the appropriate examinations required by your state and/or country
(if applicable)
Verify your proficiency in the English language, both verbal and written;
Photo attached for identification purposes
Letter must be placed in a sealed envelope with the signature of your school official across the back.

Official academic records, transcripts or certification of grades; BOTH IN ORIGNIAL LANGUAGE AND ENGLISH
TRANSLATION.

Official TOEFL score report showing a minimum score of 600 on the paper test or 250 on the computer based
tests.

Evidence of sufficient financial support for tuition and living expenses for the duration of the elective
experience (financial forms attached)

Evidence of adequate personal health insurance coverage to include coverage for both well-care and
hospitalization while in the United States.

Evidence of adequate Liability/Malpractice insurance coverage in amounts of 1 mill/3mill

Evidence of required immunization status (form attached)

CRIMINAL BACKGROUND CHECKS within one (1) year from the date of the actual elective.

PENNSYLVANIA STATE CRIMINAL BACKGROUND CHECK - ACT 34 ($10.00 fee)

http://www.portal.state.pa.us/portal/server.pt?open=512&objID=4451&PageID=458621&mode=2

PENNYLVANIA STATE CHILD ABUSE CLEARANCE - ACT 33 ($10.00 FEE)

http://www.dpw.state.pa.us/findaform/childabusehistoryclearanceforms/index.htm

When completing this form, check the CHILD CARE box on the Purpose of Clearance section. YOU MUST MAIL
THE FORM TO THE APPROPRIATE ADDRESS LISTED ON THE DOCUMENT.

FBI FINGERPRINTING CLEARANCE - ACT 73 ($33.00 fee)

http://www.pa.cogentid.com/index.htm

Provide receipt of payment, as this clearance cannot be obtained until your arrival in Pennsylvania. Upon
arrival and after you have check in with at the Universitys International Services Office, please report to the
Office of Student Affairs where you will then be directed to the nearest site to have this clearance processed.
ALL MATERIALS MUST BE MAILED TO: Visiting Elective Coordinator, University of Pittsburgh School of Medicine - Office
of Student Affairs - 3550 Terrace Street, Room S532 Scaife Hall, Pittsburgh PA 15261 USA
If accepted for this elective, upon arrival at the University of Pittsburgh you must also report to the Office of
International Services, 708 William Pitt Union. Hours are: Mon-Fri 8:30 am 5 pm.

The Office of Student Affairs is the vetting office for the Medical School. This office verifies that all items are
including in the application packet and that they conform to the requirement necessary to be considered for an
elective. ALL DECISIONS REGARDING ACCEPTANCE/DENIAL AND ASSIGNMENTS ARE THE RESPONSIBILITY
OF EACH DEPARTMENT. Correspondence from our institution will be via email only.

DEPARTMENTAL STUDENT COORDINATORS

DEPARTMENT
Anesthesiology
Cardiothoracic Surgery
Critical Care Medicine
Dermatology
Diagnostic Radiology
Emergency Medicine
Family Medicine
Internal Medicine
Neurological Surgery
Neurology
Obstetrics/Gynecology
Ophthalmology
Orthopaedic Surgery
Otolaryngology
Pathology
Pediatrics
Physical Medicine & Rehab
Plastic Surgery
Psychiatry
Radiation Oncology
Surgery
Urology

STUDENT COORDINATORS
Kathy Lee Foon
Christine Carey
Christi Charnock
Cindy McIntyre
Barb Glaneman
Mary Margaret Murtha
Patti Zahnhausen
Theresa Cullens
Melissa Lukehart
Samantha Essa
Dee Dee Greenawalt
Jane Wuenschel
Roberta Moenich
Jackie Lynch
Chris Szalkuski
Marlynn Haigh
Sara Coulter
Michelle Gigliotti
Eileen McKenna
Shannon Kroskie Smith
Kathy Haupt
Melissa Ledonne

EMAIL ADDRESS
leefoonka@anes.upmc.edu
careycr@upmc.edu
charnockcl@upmc.edu
mcintyreca@upmc.edu
glanemanbj@upmc.edu
murthamm@upmc.edu
zahnhausenpe@upmc.edu
tcullens@pitt.edu
lukehartml@pitt.edu
essas@upmc.edu
dgreenawalt@mail.magee.edu
wuenschelj@upmc.edu
moenichrj@upmc.edu
lynchjj@upmc.edu
szalkuskict@upmc.edu
Marlynn.Haigh@chp.edu
coulters@upmc.edu
gigliottim@upmc.edu
mckennae@upmc.edu
kroskiesmiths@upmc.edu
hauptkg@upmc.edu
ledonnemm@upmc.edu

PHONE
(412) 692-4500
(412) 648-6359
(412) 647-3135
(412) 648-9980
(412) 647-7053
(412) 647-8283
(412) 383-2248
(412) 692-4943
(412) 647-6777
(412) 624-1277
(412) 641-1047
(412) 232-5544
(412) 605-3262
(412) 648-6304
(412) 648-1040
(412) 692-8260
(412) 864-3721
(412) 383-8082
(412) 246-6497
(412) 623-1043
(412) 647-5314
(412) 692-4091

SUPPLEMENTAL REQUIREMENTS
This items should be sent directly to the department as per
the specific departmental information below.
Anesthesiology: Academic Transcripts, USMLE Step 1 Board Scores. Faculty letter and statement from the student,
stating why they want to do an elective in anesthesia at Pitt. Mail to: Ms. KATHY LEE FOON, Elective Coordinator,
Department of Anesthesiology, 3471 Fifth Avenue, 910 Kaufmann Building, Pittsburgh, PA 15213
Dermatology: Resume or CV. Mail to: MS. CINDY MCINTYRE, Elective Coordinator, Department of Dermatology,
Biomedical Science Tower, Suite W1041, 3501 Fifth Avenue, Pittsburgh PA 15260
Internal Medicine: Faculty letter of recommendation. Mail to: MS. THERESA CULLENS, Elective Coordinator,
Department of Internal Medicine, 3459 Fifth Avenue, Room N 713 MUH, Pittsburgh PA 15213
Neurological Surgery: Resume or CV & two (2) letters of recommendation from faculty. Mail to: MS. MELISSA
LUKEHART, Elective Coordinator, Department of Neurological Surgery, 200 Lothrop Street, Suite B461,
Pittsburgh, PA 15213
Pediatrics: PLEASE NOTE: These supplemental documents ONLY apply to elective requests specifically in the
Pediatric Dept (PEDS XXXX course numbers) Copy of students transcript up to current third year grades; statement
from student noting the number of times the USMLE step 1 exam was taken and a copy of scores. Mail to: MS.
MARLYNN HAIGH, Elective Coordinator, Department of Pediatrics, One Childrens Place, 4401 Penn Avenue, 3rd
Floor Faculty Pavillion, Pittsburgh PA 15224 or email: Marlynn.Haigh@chp.edu. Contact Ms. Haigh directly
regarding Childrens Background Check policies.
Surgery Acting Internship: CV, Unofficial transcript, USMLE scores and letter from surgery clerkship director attesting
to your performance during the surgery clerkship. Materials must be submitted prior to the evaluation of the application.
MAIL TO: Giselle G. Hamad, MD, Associate Professor of Surgery, c/o Kathy Haupt, PO Box 7533, Room F675
PUH, Pittsburgh PA 15213. PLEASE NOTE: Above surgery requirements are specifically for an Acting
Internship in Surgery and not for other Surgery related departments (ie, Urology, Otolaryngology, etc)

UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE

PERIODS FOR ACADEMIC YEAR 2014-2015
Period
1
3
5
7
9
11
12.5

Start
05/05/14
06/30/14
08/25/14
10/27/14
01/05/15
03/02/15
04/27/15

End
06/01/14
07/27/14
09/21/14
11/23/14
02/01/15
03/29/15
05/17/15

Period
2
4
6
8
10
12

Start
06/02/14
07/28/14
09/22/14
11/24/14
02/02/15
03/30/15

End
06/29/14
08/24/14
10/19/14
12/21/14
03/01/15
04/26/15