Sunday, May 11, 2008    Home | About O'Bleness | News | Services | Physicians | Health Resources | Medical Education | Calendar   Rotation Application  To be completed by student, intern or resident Name Social Security # College Year Grad Level of Training Sex Male Female   Address where correspondence regarding rotation is to be mailed Address City State Zip Code  -  find zip code Telephone (  )    -  E-Mail Address Requested Rotation Requested Preceptor Course number if applicable   Requested Dates Begin Monday End Friday If my requested rotation and/or preceptor is not available during the dues requested, I will accept the following alternative rotation(s) in the oder listed. Otherwise, I have checked none 1st Choice  2nd Choice  None   Do you have Health Insurance?  Yes No Do you have Malpractice Insurance?  Yes No   Housing PLEASE NOTE: Housing is a two (2) bedroom co-ed apartment, maximum occupancy is two (2) tenants. If this is unacceptable to you, other housing arrangements are your responsibility Required Not required Not Available    Please give us CORE contact information (required) Name Address City State Zip Code  -  find zip code Telephone (  )    -     Date of application : 5/11/2008

55 Hospital Drive, Athens, OH 45701-2302 Phone: (740) 593-5551