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UROLOGY APPLICATION PILOT

APPLICATION
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REIMAGINE YOUR RESIDENCY APPLICATION

SHARP

First Name

Gender

Last Name

Preferred Pronouns

Race/ethnicity

Date of Birth

Phone

Email

Mailing Address

City

State

Postal / Zip code

Country

Medical School

Medical School Dean of Students

Medical School Phone Number

Upload USMLE Step 1 Documentation

Upload Medical School Letter of Good Standing

I grant permission for my scores generated from SHARP to be shared with my future residency program if I ultimately match through the standard SAU urology match

Preferred Interview Location

I certify that I have never been convicted of a misdemeanor or felony

I certify that I am a US Citizen or National, Legal Permanent Resident, Refugee or Asylee

Thank you! We’ll be in touch.

CONTACT INFORMATION

University of California Irvine
Residency Website

Program Coordinator

Molly Blair mcblair@hs.uci.edu

Program Director

Mark Jordan mljordan@hs.uci.edu

Associate PD

Heidi Stephany hstepha1@hs.uci.edu

Tel: 714-456-6719

Zucker SOM at Hofstra/Northwell
Residency Website

Program Coordinator

Jennifer Tidridge jtidridge@northwell.edu

Program Director

Michael Schwartz mschwartz5@northwell.edu

Associate PDs

Jessica Kreshover jkreshover@northwell.edu

Jane Cho jcho9@northwell.edu

Tel: 516-734-8567

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