Away Elective Form

  • This form is to be completed by M4s upon acceptance of a position at an away institution.
  • Typically, no more than two (2) away electives may be taken and no more than two (2) away electives may be taken at the same institution (must be different clinical experiences).
  • 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 2022-2023 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