Instructions

Fill out the following form completely before clicking submit. If there is a ? symbol by a question, clicking on it will give you more information.

Enter your Student ID: Students have an ID number with a T and either two or three zeros followed by 6 digits. Include the letter T and all zeros. *

Enter your TOURO email *

First Name *

Last Name *

Start date of Clinical Distinction rotation: * +

End date of Clinical Distinction rotation: * +

Which course are you completing? *

CLIN 717 (CD I)

CLIN 718 (CD II)