Away Elective Form

Students (Class of 2022) are limited to one away rotation adhering to the guidelines by the Coalition for Physician Accountability released on 1/25/2021.

  • This form is to be completed by M4s upon acceptance of a position at an away institution.
  • Typically, no more than four (4) away electives may be taken and no more than two (2) away electives may be taken at the same institution.
  • If required, please drop any registered course during the same module when the away elective is taking place. Away elective course registration cannot take place if already registered for another course. Please have this step completed prior to submitting this form.
  • Please refer to the 2021-2022 calendar for M4 module dates.
Information for your away elective institution:
  • Provide an evaluation form to the supervising faculty to complete before you leave the away institution.
  • Send all correspondence about away elective(s) to the JSMBS Registrar.


Send all correspondence about away electives to:


Sherene Milizia.

Sherene Milizia


Office of Student and Academic Affairs

955 Main Street, Room 1205 Buffalo, NY 14203-1121

Phone: (716) 829-2802; Fax: (716) 829-2798