We'd like to learn more about you
...because you're here to be become an outstanding physician and we're here to help get you there. As part of our mentorship program, we'd like to gather some information that will help us pair you with a mentor during internship. Don't worry, nothing is set in stone. We know interests and future plans change, and you may seek additional mentors. But this will give us a start.
Hobbies and interests: (optional)
Important things in your life: (optional)
High school of graduation: (optional; for informational purposes)
Career Plans: Which career paths are you most interested in?
Now, let's consider some factors for scheduling
When do you expect this? Please add any additional comments.
And finally, let's discuss some specific scheduling requests
Ophthalmology Track
Ophtho track interns will each be assigned to a 6-week Ophtho block at Olive View and a 6-week Ophtho block at the West LA VA. When not on Ophtho block, your schedule will typically follow the 4+1 schedule with Internal Medicine.
Ophtho rotations and Ambulatory blocks (outpatient "+1" weeks) will be pre-scheduled according to the available options. Other clinical rotations (inpatient and medicine subspecialties) and vacation will be assigned thereafter. Rotations must fit into the two-week blocks outlined in black.
Ophthalmology Block Schedule Options
Instructions: Look at the available Ophtho block schedule options . Select up to 3 preferred schedules, from most to least preferred.
—Please choose an option— Option A Option B Option C Option D Option E Option F Option G
—Please choose an option— Option A Option B Option C Option D Option E Option F Option G
—Please choose an option— Option A Option B Option C Option D Option E Option F Option G
For Internal Medicine, we will continue with our 4+1 schedule, meaning your schedule will follow the pattern of a four-week rotation (or 2 two-week rotations) followed by one week of Ambulatory Medicine ("+1" or "Amb week") every fifth week.
These rotations will follow the block schedule that you can view here . The chart identifies the block starting dates for the entire academic year. The blocks generally start on Thursday and end on Wednesday, with the exception being the first and last blocks of the academic year.
Block Schedule Dates for 2024-2025
Vacation Request
Use this section to place your vacation requests. Each housestaff receives 4 weeks of vacation per year, split into 2 two-week blocks. Vacation blocks cannot interfere with +1 Ambulatory blocks.
Please note that the number of vacationers during any given block will be limited, so please indicate if certain dates are very important (e.g. you're getting married). Thanksgiving, Christmas, New Years, and Memorial Day are very popular, but only a small number will get vacation during these times. Therefore we cannot guarantee vacation requests, but we will do our best to accommodate.
Instructions: Choose your vacation preferences based on the available options. Available blocks are subject to change. If you do not have specific vacation dates in mind, choose "Best Available" and we will schedule vacation blocks for you, usually spread apart as much as possible. Vacation blocks should not interfere with Ophtho or +1 Amb blocks.
—Please choose an option— Best Available P Weeks 2-3: 7/4/24 - 7/17/24 P Weeks 5-6: 7/25/24 - 8/7/24 P Weeks 19-20: 10/31/24 - 11/13/24 P Weeks 22-23: 11/21/24 - 12/4/24 P Weeks 25-26: 12/12/24 - 12/25/24 P Weeks 27-28: 12/26/24 - 1/8/25 P Weeks 31-32: 1/23/25 - 2/5/25 P Weeks 33-34: 2/6/25 - 2/19/25 P Weeks 37-38: 3/6/25 - 3/19/25 P Weeks 45-46: 5/1/25 - 5/14/25 P Weeks 47-48: 5/15/25 - 5/28/25 P Weeks 49-50: 5/29/25 - 6/11/25
—Please choose an option— Best Available P Weeks 2-3: 7/4/24 - 7/17/24 P Weeks 5-6: 7/25/24 - 8/7/24 P Weeks 19-20: 10/31/24 - 11/13/24 P Weeks 22-23: 11/21/24 - 12/4/24 P Weeks 25-26: 12/12/24 - 12/25/24 P Weeks 27-28: 12/26/24 - 1/8/25 P Weeks 31-32: 1/23/25 - 2/5/25 P Weeks 33-34: 2/6/25 - 2/19/25 P Weeks 37-38: 3/6/25 - 3/19/25 P Weeks 45-46: 5/1/25 - 5/14/25 P Weeks 47-48: 5/15/25 - 5/28/25 P Weeks 49-50: 5/29/25 - 6/11/25
—Please choose an option— Best Available P Weeks 2-3: 7/4/24 - 7/17/24 P Weeks 5-6: 7/25/24 - 8/7/24 P Weeks 19-20: 10/31/24 - 11/13/24 P Weeks 22-23: 11/21/24 - 12/4/24 P Weeks 25-26: 12/12/24 - 12/25/24 P Weeks 27-28: 12/26/24 - 1/8/25 P Weeks 31-32: 1/23/25 - 2/5/25 P Weeks 33-34: 2/6/25 - 2/19/25 P Weeks 37-38: 3/6/25 - 3/19/25 P Weeks 45-46: 5/1/25 - 5/14/25 P Weeks 47-48: 5/15/25 - 5/28/25 P Weeks 49-50: 5/29/25 - 6/11/25
—Please choose an option— Best Available P Weeks 2-3: 7/4/24 - 7/17/24 P Weeks 5-6: 7/25/24 - 8/7/24 P Weeks 19-20: 10/31/24 - 11/13/24 P Weeks 22-23: 11/21/24 - 12/4/24 P Weeks 25-26: 12/12/24 - 12/25/24 P Weeks 27-28: 12/26/24 - 1/8/25 P Weeks 31-32: 1/23/25 - 2/5/25 P Weeks 33-34: 2/6/25 - 2/19/25 P Weeks 37-38: 3/6/25 - 3/19/25 P Weeks 45-46: 5/1/25 - 5/14/25 P Weeks 47-48: 5/15/25 - 5/28/25 P Weeks 49-50: 5/29/25 - 6/11/25
Comments:
Based on your vacation requests, you will be assigned to a Pod, which determines the assignment to +1 Amb week for the entire year and residency.
Instructions: If you have specific vacation preferences, look at the available vacation blocks below. Then choose the group that best matches your preferences. Available blocks are subject to change. If you do not have specific vacation dates in mind, choose "Best Available" and we will schedule vacation blocks for you. We usually find vacation blocks that are spread apart.
Group
Vacation Block Options
Group A
Week 2-3: 7/4/24 - 7/17/24
Week 7-8: 8/8/24 - 8/21/24
Week 10-11: 8/29/24 - 9/11/24
Week 12-13: 9/12/24 - 9/25/24
Week 15-16: 10/3/24 - 10/16/24
Week 20-21: 11/7/24 - 11/20/24
Week 25-26: 12/12/24 - 12/25/24
Week 27-28: 12/26/24 - 1/8/25
Week 32-33: 1/30/25 - 2/12/25
Week 37-38: 3/6/25 - 3/19/25
Week 40-41: 3/27/25 - 4/9/25
Group B
Week 6-7: 8/1/24 - 8/14/24
Week 18-19: 10/24/24 - 11/6/24
Week 21-22: 11/14/24 - 11/27/24
Week 23-24: 11/28/24 - 12/11/24
Week 33-34: 2/6/25 - 2/19/25
Week 36-37: 2/27/25 - 3/12/25
Week 41-42: 4/3/25 - 4/16/25
Week 43-44: 4/17/25 - 4/30/25
Week 48-49: 5/22/25 - 6/4/25
Week 51-52: 6/12/25 - 6/23/25
Group C
Week 2-3: 7/4/24 - 7/17/24
Week 4-5: 7/18/24 - 7/31/24
Week 7-8: 8/8/24 - 8/21/24
Week 8-9: 8/15/24 - 8/28/24
Week 9-10: 8/22/24 - 9/4/24
Week 24-25: 12/5/24 - 12/18/24
Week 29-30: 1/9/25 - 1/22/25
Week 32-33: 1/30/25 - 2/12/25
Week 37-38: 3/6/25 - 3/19/25
Week 42-43: 4/10/25 - 4/23/25
Week 47-48: 5/15/25 - 5/28/25
Week 49-50: 5/29/25 - 6/11/25
Group D
Week 5-6: 7/25/24 - 8/7/24
Week 15-16: 10/3/24 - 10/16/24
Week 18-19: 10/24/24 - 11/6/24
Week 23-24: 11/28/24 - 12/11/24
Week 28-29: 1/2/25 - 1/15/25
Week 30-31: 1/16/25 - 1/29/25
Week 35-36: 2/20/25 - 3/5/25
Week 43-44: 4/17/25 - 4/30/25
Week 50-51: 6/5/25 - 6/18/25
Group E
Week 4-5: 7/18/24 - 7/31/24
Week 6-7: 8/1/24 - 8/14/24
Week 9-10: 8/22/24 - 9/4/24
Week 16-17: 10/10/24 - 10/23/24
Week 21-22: 11/14/24 - 11/27/24
Week 24-25: 12/5/24 - 12/18/24
Week 31-32: 1/23/25 - 2/5/25
Week 41-42: 4/3/25 - 4/16/25
Week 49-50: 5/29/25 - 6/11/25
Week 51-52: 6/12/25 - 6/23/25
First Set of Vacation Preferences
Select the group, then up to 4 options. We will try to assign two vacation blocks among this first set of preferences.
Group: —Please choose an option— Best Available Group A Group B Group C Group D Group E
Option 1: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/17/24 A Weeks 7-8: 8/8/24 - 8/21/24 A Weeks 10-11: 8/29/24 - 9/11/24 A Weeks 12-13: 9/12/24 - 9/25/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/20/24 A Weeks 25-26: 12/12/24 - 12/25/24 A Weeks 27-28: 12/26/24 - 1/8/25 A Weeks 32-33: 1/30/25 - 2/12/25 A Weeks 37-38: 3/6/25 - 3/19/25 A Weeks 40-41: 3/27/25 - 4/9/25
Option 2: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/17/24 A Weeks 7-8: 8/8/24 - 8/21/24 A Weeks 10-11: 8/29/24 - 9/11/24 A Weeks 12-13: 9/12/24 - 9/25/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/20/24 A Weeks 25-26: 12/12/24 - 12/25/24 A Weeks 27-28: 12/26/24 - 1/8/25 A Weeks 32-33: 1/30/25 - 2/12/25 A Weeks 37-38: 3/6/25 - 3/19/25 A Weeks 40-41: 3/27/25 - 4/9/25
Option 3: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/17/24 A Weeks 7-8: 8/8/24 - 8/21/24 A Weeks 10-11: 8/29/24 - 9/11/24 A Weeks 12-13: 9/12/24 - 9/25/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/20/24 A Weeks 25-26: 12/12/24 - 12/25/24 A Weeks 27-28: 12/26/24 - 1/8/25 A Weeks 32-33: 1/30/25 - 2/12/25 A Weeks 37-38: 3/6/25 - 3/19/25 A Weeks 40-41: 3/27/25 - 4/9/25
Option 4: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/17/24 A Weeks 7-8: 8/8/24 - 8/21/24 A Weeks 10-11: 8/29/24 - 9/11/24 A Weeks 12-13: 9/12/24 - 9/25/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/20/24 A Weeks 25-26: 12/12/24 - 12/25/24 A Weeks 27-28: 12/26/24 - 1/8/25 A Weeks 32-33: 1/30/25 - 2/12/25 A Weeks 37-38: 3/6/25 - 3/19/25 A Weeks 40-41: 3/27/25 - 4/9/25
Option 1: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 11/6/24 B Weeks 21-22: 11/14/24 - 11/27/24 B Weeks 23-24: 11/28/24 - 12/11/24 B Weeks 33-34: 2/6/25 - 2/19/25 B Weeks 36-37: 2/27/25 - 3/12/25 B Weeks 41-42: 4/3/25 - 4/16/25 B Weeks 43-44: 4/17/25 - 4/30/25 B Weeks 48-49: 5/22/25 - 6/4/25 B Weeks 51-52: 6/12/25 - 6/23/25
Option 2: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 11/6/24 B Weeks 21-22: 11/14/24 - 11/27/24 B Weeks 23-24: 11/28/24 - 12/11/24 B Weeks 33-34: 2/6/25 - 2/19/25 B Weeks 36-37: 2/27/25 - 3/12/25 B Weeks 41-42: 4/3/25 - 4/16/25 B Weeks 43-44: 4/17/25 - 4/30/25 B Weeks 48-49: 5/22/25 - 6/4/25 B Weeks 51-52: 6/12/25 - 6/23/25
Option 3: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 11/6/24 B Weeks 21-22: 11/14/24 - 11/27/24 B Weeks 23-24: 11/28/24 - 12/11/24 B Weeks 33-34: 2/6/25 - 2/19/25 B Weeks 36-37: 2/27/25 - 3/12/25 B Weeks 41-42: 4/3/25 - 4/16/25 B Weeks 43-44: 4/17/25 - 4/30/25 B Weeks 48-49: 5/22/25 - 6/4/25 B Weeks 51-52: 6/12/25 - 6/23/25
Option 4: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 11/6/24 B Weeks 21-22: 11/14/24 - 11/27/24 B Weeks 23-24: 11/28/24 - 12/11/24 B Weeks 33-34: 2/6/25 - 2/19/25 B Weeks 36-37: 2/27/25 - 3/12/25 B Weeks 41-42: 4/3/25 - 4/16/25 B Weeks 43-44: 4/17/25 - 4/30/25 B Weeks 48-49: 5/22/25 - 6/4/25 B Weeks 51-52: 6/12/25 - 6/23/25
Option 1: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/17/24 C Weeks 4-5: 7/18/24 - 7/31/24 C Weeks 7-8: 8/8/24 - 8/21/24 C Weeks 8-9: 8/15/24 - 8/28/24 C Weeks 9-10: 8/22/24 - 9/4/24 C Weeks 24-25: 12/5/24 - 12/18/24 C Weeks 29-30: 1/9/25 - 1/22/25 C Weeks 32-33: 1/30/25 - 2/12/25 C Weeks 37-38: 3/6/25 - 3/19/25 C Weeks 42-43: 4/10/25 - 4/23/25 C Weeks 47-48: 5/15/25 - 5/28/25 C Weeks 49-50: 5/29/25 - 6/11/25
Option 2: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/17/24 C Weeks 4-5: 7/18/24 - 7/31/24 C Weeks 7-8: 8/8/24 - 8/21/24 C Weeks 8-9: 8/15/24 - 8/28/24 C Weeks 9-10: 8/22/24 - 9/4/24 C Weeks 24-25: 12/5/24 - 12/18/24 C Weeks 29-30: 1/9/25 - 1/22/25 C Weeks 32-33: 1/30/25 - 2/12/25 C Weeks 37-38: 3/6/25 - 3/19/25 C Weeks 42-43: 4/10/25 - 4/23/25 C Weeks 47-48: 5/15/25 - 5/28/25 C Weeks 49-50: 5/29/25 - 6/11/25
Option 3: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/17/24 C Weeks 4-5: 7/18/24 - 7/31/24 C Weeks 7-8: 8/8/24 - 8/21/24 C Weeks 8-9: 8/15/24 - 8/28/24 C Weeks 9-10: 8/22/24 - 9/4/24 C Weeks 24-25: 12/5/24 - 12/18/24 C Weeks 29-30: 1/9/25 - 1/22/25 C Weeks 32-33: 1/30/25 - 2/12/25 C Weeks 37-38: 3/6/25 - 3/19/25 C Weeks 42-43: 4/10/25 - 4/23/25 C Weeks 47-48: 5/15/25 - 5/28/25 C Weeks 49-50: 5/29/25 - 6/11/25
Option 4: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/17/24 C Weeks 4-5: 7/18/24 - 7/31/24 C Weeks 7-8: 8/8/24 - 8/21/24 C Weeks 8-9: 8/15/24 - 8/28/24 C Weeks 9-10: 8/22/24 - 9/4/24 C Weeks 24-25: 12/5/24 - 12/18/24 C Weeks 29-30: 1/9/25 - 1/22/25 C Weeks 32-33: 1/30/25 - 2/12/25 C Weeks 37-38: 3/6/25 - 3/19/25 C Weeks 42-43: 4/10/25 - 4/23/25 C Weeks 47-48: 5/15/25 - 5/28/25 C Weeks 49-50: 5/29/25 - 6/11/25
Option 1: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 11/6/24 D Weeks 23-24: 11/28/24 - 12/11/24 D Weeks 28-29: 1/2/25 - 1/15/25 D Weeks 30-31: 1/16/25 - 1/29/25 D Weeks 35-36: 2/20/25 - 3/5/25 D Weeks 43-44: 4/17/25 - 4/30/25 D Weeks 50-51: 6/5/25 - 6/18/25
Option 2: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 11/6/24 D Weeks 23-24: 11/28/24 - 12/11/24 D Weeks 28-29: 1/2/25 - 1/15/25 D Weeks 30-31: 1/16/25 - 1/29/25 D Weeks 35-36: 2/20/25 - 3/5/25 D Weeks 43-44: 4/17/25 - 4/30/25 D Weeks 50-51: 6/5/25 - 6/18/25
Option 3: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 11/6/24 D Weeks 23-24: 11/28/24 - 12/11/24 D Weeks 28-29: 1/2/25 - 1/15/25 D Weeks 30-31: 1/16/25 - 1/29/25 D Weeks 35-36: 2/20/25 - 3/5/25 D Weeks 43-44: 4/17/25 - 4/30/25 D Weeks 50-51: 6/5/25 - 6/18/25
Option 4: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 11/6/24 D Weeks 23-24: 11/28/24 - 12/11/24 D Weeks 28-29: 1/2/25 - 1/15/25 D Weeks 30-31: 1/16/25 - 1/29/25 D Weeks 35-36: 2/20/25 - 3/5/25 D Weeks 43-44: 4/17/25 - 4/30/25 D Weeks 50-51: 6/5/25 - 6/18/25
Option 1: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/31/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 9/4/24 E Weeks 16-17: 10/10/24 - 10/23/24 E Weeks 21-22: 11/14/24 - 11/27/24 E Weeks 24-25: 12/5/24 - 12/18/24 E Weeks 31-32: 1/23/25 - 2/5/25 E Weeks 41-42: 4/3/25 - 4/16/25 E Weeks 49-50: 5/29/25 - 6/11/25 E Weeks 51-52: 6/12/25 - 6/23/25
Option 2: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/31/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 9/4/24 E Weeks 16-17: 10/10/24 - 10/23/24 E Weeks 21-22: 11/14/24 - 11/27/24 E Weeks 24-25: 12/5/24 - 12/18/24 E Weeks 31-32: 1/23/25 - 2/5/25 E Weeks 41-42: 4/3/25 - 4/16/25 E Weeks 49-50: 5/29/25 - 6/11/25 E Weeks 51-52: 6/12/25 - 6/23/25
Option 3: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/31/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 9/4/24 E Weeks 16-17: 10/10/24 - 10/23/24 E Weeks 21-22: 11/14/24 - 11/27/24 E Weeks 24-25: 12/5/24 - 12/18/24 E Weeks 31-32: 1/23/25 - 2/5/25 E Weeks 41-42: 4/3/25 - 4/16/25 E Weeks 49-50: 5/29/25 - 6/11/25 E Weeks 51-52: 6/12/25 - 6/23/25
Option 4: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/31/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 9/4/24 E Weeks 16-17: 10/10/24 - 10/23/24 E Weeks 21-22: 11/14/24 - 11/27/24 E Weeks 24-25: 12/5/24 - 12/18/24 E Weeks 31-32: 1/23/25 - 2/5/25 E Weeks 41-42: 4/3/25 - 4/16/25 E Weeks 49-50: 5/29/25 - 6/11/25 E Weeks 51-52: 6/12/25 - 6/23/25
Other/Comments:
Second Set of Vacation Preferences
Select a different group than above, then up to 4 options. We will use this set if we cannot accommodate your first set of preferences.
Group: —Please choose an option— Group A Group B Group C Group D Group E
Option 1: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/11/24 A Weeks 7-8: 8/8/24 - 8/15/24 A Weeks 10-11: 8/29/24 - 9/5/24 A Weeks 12-13: 9/12/24 - 9/19/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/14/24 A Weeks 25-26: 12/12/24 - 12/19/24 A Weeks 27-28: 12/26/24 - 1/2/25 A Weeks 32-33: 1/30/25 - 2/6/25 A Weeks 37-38: 3/6/25 - 3/13/25 A Weeks 40-41: 3/27/25 - 4/3/25
Option 2: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/11/24 A Weeks 7-8: 8/8/24 - 8/15/24 A Weeks 10-11: 8/29/24 - 9/5/24 A Weeks 12-13: 9/12/24 - 9/19/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/14/24 A Weeks 25-26: 12/12/24 - 12/19/24 A Weeks 27-28: 12/26/24 - 1/2/25 A Weeks 32-33: 1/30/25 - 2/6/25 A Weeks 37-38: 3/6/25 - 3/13/25 A Weeks 40-41: 3/27/25 - 4/3/25
Option 3: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/11/24 A Weeks 7-8: 8/8/24 - 8/15/24 A Weeks 10-11: 8/29/24 - 9/5/24 A Weeks 12-13: 9/12/24 - 9/19/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/14/24 A Weeks 25-26: 12/12/24 - 12/19/24 A Weeks 27-28: 12/26/24 - 1/2/25 A Weeks 32-33: 1/30/25 - 2/6/25 A Weeks 37-38: 3/6/25 - 3/13/25 A Weeks 40-41: 3/27/25 - 4/3/25
Option 4: —Please choose an option— Best Available A Weeks 2-3: 7/4/24 - 7/11/24 A Weeks 7-8: 8/8/24 - 8/15/24 A Weeks 10-11: 8/29/24 - 9/5/24 A Weeks 12-13: 9/12/24 - 9/19/24 A Weeks 15-16: 10/3/24 - 10/16/24 A Weeks 20-21: 11/7/24 - 11/14/24 A Weeks 25-26: 12/12/24 - 12/19/24 A Weeks 27-28: 12/26/24 - 1/2/25 A Weeks 32-33: 1/30/25 - 2/6/25 A Weeks 37-38: 3/6/25 - 3/13/25 A Weeks 40-41: 3/27/25 - 4/3/25
Option 1: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 10/31/24 B Weeks 21-22: 11/14/24 - 11/21/24 B Weeks 23-24: 11/28/24 - 12/5/24 B Weeks 33-34: 2/6/25 - 2/13/25 B Weeks 36-37: 2/27/25 - 3/6/25 B Weeks 41-42: 4/3/25 - 4/10/25 B Weeks 43-44: 4/17/25 - 4/24/25 B Weeks 48-49: 5/22/25 - 5/29/25 B Weeks 51-52: 6/12/25 - 6/19/25
Option 2: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 10/31/24 B Weeks 21-22: 11/14/24 - 11/21/24 B Weeks 23-24: 11/28/24 - 12/5/24 B Weeks 33-34: 2/6/25 - 2/13/25 B Weeks 36-37: 2/27/25 - 3/6/25 B Weeks 41-42: 4/3/25 - 4/10/25 B Weeks 43-44: 4/17/25 - 4/24/25 B Weeks 48-49: 5/22/25 - 5/29/25 B Weeks 51-52: 6/12/25 - 6/19/25
Option 3: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 10/31/24 B Weeks 21-22: 11/14/24 - 11/21/24 B Weeks 23-24: 11/28/24 - 12/5/24 B Weeks 33-34: 2/6/25 - 2/13/25 B Weeks 36-37: 2/27/25 - 3/6/25 B Weeks 41-42: 4/3/25 - 4/10/25 B Weeks 43-44: 4/17/25 - 4/24/25 B Weeks 48-49: 5/22/25 - 5/29/25 B Weeks 51-52: 6/12/25 - 6/19/25
Option 4: —Please choose an option— Best Available B Weeks 6-7: 8/1/24 - 8/14/24 B Weeks 18-19: 10/24/24 - 10/31/24 B Weeks 21-22: 11/14/24 - 11/21/24 B Weeks 23-24: 11/28/24 - 12/5/24 B Weeks 33-34: 2/6/25 - 2/13/25 B Weeks 36-37: 2/27/25 - 3/6/25 B Weeks 41-42: 4/3/25 - 4/10/25 B Weeks 43-44: 4/17/25 - 4/24/25 B Weeks 48-49: 5/22/25 - 5/29/25 B Weeks 51-52: 6/12/25 - 6/19/25
Option 1: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/11/24 C Weeks 4-5: 7/18/24 - 7/25/24 C Weeks 7-8: 8/8/24 - 8/15/24 C Weeks 8-9: 8/22/24 - 8/29/24 C Weeks 9-10: 8/22/24 - 8/29/24 C Weeks 24-25: 12/5/24 - 12/12/24 C Weeks 29-30: 1/9/25 - 1/16/25 C Weeks 32-33: 1/30/25 - 2/6/25 C Weeks 37-38: 3/6/25 - 3/13/25 C Weeks 42-43: 4/10/25 - 4/17/25 C Weeks 47-48: 5/15/25 - 5/22/25 C Weeks 49-50: 5/29/25 - 6/5/25
Option 2: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/11/24 C Weeks 4-5: 7/18/24 - 7/25/24 C Weeks 7-8: 8/8/24 - 8/15/24 C Weeks 8-9: 8/22/24 - 8/29/24 C Weeks 9-10: 8/22/24 - 8/29/24 C Weeks 24-25: 12/5/24 - 12/12/24 C Weeks 29-30: 1/9/25 - 1/16/25 C Weeks 32-33: 1/30/25 - 2/6/25 C Weeks 37-38: 3/6/25 - 3/13/25 C Weeks 42-43: 4/10/25 - 4/17/25 C Weeks 47-48: 5/15/25 - 5/22/25 C Weeks 49-50: 5/29/25 - 6/5/25
Option 3: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/11/24 C Weeks 4-5: 7/18/24 - 7/25/24 C Weeks 7-8: 8/8/24 - 8/15/24 C Weeks 8-9: 8/22/24 - 8/29/24 C Weeks 9-10: 8/22/24 - 8/29/24 C Weeks 24-25: 12/5/24 - 12/12/24 C Weeks 29-30: 1/9/25 - 1/16/25 C Weeks 32-33: 1/30/25 - 2/6/25 C Weeks 37-38: 3/6/25 - 3/13/25 C Weeks 42-43: 4/10/25 - 4/17/25 C Weeks 47-48: 5/15/25 - 5/22/25 C Weeks 49-50: 5/29/25 - 6/5/25
Option 4: —Please choose an option— Best Available C Weeks 2-3: 7/4/24 - 7/11/24 C Weeks 4-5: 7/18/24 - 7/25/24 C Weeks 7-8: 8/8/24 - 8/15/24 C Weeks 8-9: 8/22/24 - 8/29/24 C Weeks 9-10: 8/22/24 - 8/29/24 C Weeks 24-25: 12/5/24 - 12/12/24 C Weeks 29-30: 1/9/25 - 1/16/25 C Weeks 32-33: 1/30/25 - 2/6/25 C Weeks 37-38: 3/6/25 - 3/13/25 C Weeks 42-43: 4/10/25 - 4/17/25 C Weeks 47-48: 5/15/25 - 5/22/25 C Weeks 49-50: 5/29/25 - 6/5/25
Option 1: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 10/31/24 D Weeks 23-24: 11/28/24 - 12/5/24 D Weeks 28-29: 1/2/25 - 1/9/25 D Weeks 30-31: 1/16/25 - 1/23/25 D Weeks 35-36: 2/20/25 - 2/27/25 D Weeks 43-44: 4/17/25 - 4/24/25 D Weeks 50-51: 6/5/25 - 6/12/25
Option 2: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 10/31/24 D Weeks 23-24: 11/28/24 - 12/5/24 D Weeks 28-29: 1/2/25 - 1/9/25 D Weeks 30-31: 1/16/25 - 1/23/25 D Weeks 35-36: 2/20/25 - 2/27/25 D Weeks 43-44: 4/17/25 - 4/24/25 D Weeks 50-51: 6/5/25 - 6/12/25
Option 3: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 10/31/24 D Weeks 23-24: 11/28/24 - 12/5/24 D Weeks 28-29: 1/2/25 - 1/9/25 D Weeks 30-31: 1/16/25 - 1/23/25 D Weeks 35-36: 2/20/25 - 2/27/25 D Weeks 43-44: 4/17/25 - 4/24/25 D Weeks 50-51: 6/5/25 - 6/12/25
Option 4: —Please choose an option— Best Available D Weeks 5-6: 7/25/24 - 8/7/24 D Weeks 15-16: 10/3/24 - 10/16/24 D Weeks 18-19: 10/24/24 - 10/31/24 D Weeks 23-24: 11/28/24 - 12/5/24 D Weeks 28-29: 1/2/25 - 1/9/25 D Weeks 30-31: 1/16/25 - 1/23/25 D Weeks 35-36: 2/20/25 - 2/27/25 D Weeks 43-44: 4/17/25 - 4/24/25 D Weeks 50-51: 6/5/25 - 6/12/25
Option 1: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/25/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 8/29/24 E Weeks 16-17: 10/10/24 - 10/17/24 E Weeks 21-22: 11/14/24 - 11/21/24 E Weeks 24-25: 12/5/24 - 12/12/24 E Weeks 31-32: 1/23/25 - 1/30/25 E Weeks 41-42: 4/3/25 - 4/10/25 E Weeks 49-50: 5/29/25 - 6/5/25 E Weeks 51-52: 6/12/25 - 6/19/25
Option 2: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/25/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 8/29/24 E Weeks 16-17: 10/10/24 - 10/17/24 E Weeks 21-22: 11/14/24 - 11/21/24 E Weeks 24-25: 12/5/24 - 12/12/24 E Weeks 31-32: 1/23/25 - 1/30/25 E Weeks 41-42: 4/3/25 - 4/10/25 E Weeks 49-50: 5/29/25 - 6/5/25 E Weeks 51-52: 6/12/25 - 6/19/25
Option 3: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/25/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 8/29/24 E Weeks 16-17: 10/10/24 - 10/17/24 E Weeks 21-22: 11/14/24 - 11/21/24 E Weeks 24-25: 12/5/24 - 12/12/24 E Weeks 31-32: 1/23/25 - 1/30/25 E Weeks 41-42: 4/3/25 - 4/10/25 E Weeks 49-50: 5/29/25 - 6/5/25 E Weeks 51-52: 6/12/25 - 6/19/25
Option 4: —Please choose an option— Best Available E Weeks 4-5: 7/18/24 - 7/25/24 E Weeks 6-7: 8/1/24 - 8/14/24 E Weeks 9-10: 8/22/24 - 8/29/24 E Weeks 16-17: 10/10/24 - 10/17/24 E Weeks 21-22: 11/14/24 - 11/21/24 E Weeks 24-25: 12/5/24 - 12/12/24 E Weeks 31-32: 1/23/25 - 1/30/25 E Weeks 41-42: 4/3/25 - 4/10/25 E Weeks 49-50: 5/29/25 - 6/5/25 E Weeks 51-52: 6/12/25 - 6/19/25
Other/Comments:
Prioritize your requests
Arrange the requests above from most to least important (okay to leave blanks) .
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
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