Osteopathic Manipulative Medicine 
PCOM Student Elective Rotation

Applicants must complete the OMM Elective Application form below. After the form has been submitted, a representative will follow up with you regarding program availability. If needed, the representative will request additional required documents.

Elective Application Form

If you see this don't fill out this input box.

* Indicates required field

*Name

*Email address

*Current Street Address

*City

*State

*Zip code

*Mobile phone number

*Alternate phone number

*Medical School

*Year of Graduation

*Rotation dates - choices 1, 2 and 3

Type of rotation requested

AuditionNon-Audition

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If requested, applicants must submit the following documents:

• Photo
• CV
• Copy of health insurance card (front and back)
• Certificate of malpractice insurance (minimum of $1 million/$3 million, current at time of requested rotation dates)
• Letter of good standing
• State criminal background check (within two years of the requested rotation dates - this clearance may be obtained in your state)
• PA FBI fingerprinting clearance (within two years of the requested rotation dates)
• PA child abuse clearance (within two years of the requested rotation dates)
• Immunization records
• PPD test results (within one year of the requested rotation dates)
• Flu shot verification (within one year of the requested rotation dates)
• Mask fit test results (within one year of the requested rotation dates)
• Affiliation agreements are needed for non-PCOM students, please check with your school to confirm that an agreement between PCOM and your school is in place in order to complete your audition or non-audition request.

• Audition rotation for the residency program and elective rotation