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Rezi prep 360 Intake Form

In order to develop a personalized game plan to secure a Post Graduate Year 1 (PGY1) and/or 2, please complete this form with as much detail as possible. The information provided will help us learn more about your goals, clinical areas of interest, and qualities you value that the program of your choice must embody.

Saley Traore-Uwalaka

Founder & CEO

Saley Traore-Uwalaka

Founder & CEO

A small river named Duden flows by their place and supplies it with the necessary regelialia. It is a paradisematic country, in which roasted parts of sentences fly into your mouth. Even the all-powerful Pointing has no control about the blind texts it is an almost orthographic life One day however a small line of blind text by the name of Lorem Ipsum decided to leave for the far World of Grammar. The Big Oxmox advised her not to do so, because

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First Name

Last Name

Email Address

Date of Graduation

What type of residency are you seeking to secure?

PGY 1 only

PGY 2

PGY1 and PGY2 Combination

I am not sure at the moment

What area of residency training are you interested in?

Pharmacy Practice Residency

Community Residency

Managed Care

Professional Organization Management/Executive Resident

I am not sure at the moment

What are your current clinical areas of interest? Select all that applies.

Infectious Diseases

Cardiology

Transplant

Oncology

Drug Information

Critical Care

Emergency Medicine

Pediatric

HIV

Internal Medicine

Informatics

Administration and Health Systems Management

Medication Use and Safety

Ambulatory Care

Geriatrics

Academia

I am not sure at the moment

Are you limited geographically?

YES, I only want to apply in a particular state or geographical area

NO, I am open to applying all over the country

How many programs are you considering applying to?

1-5

6-10

I am not sure

Is there anything else you would like us to know about your search and/or residency interest?

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