Apply On-Line

Please fill out the application below and press [Submit]. Upon receipt, St. Barnabas Hospital will mail you a complete internship application, which in addition to the information requested below will require: 1) a Dean's letter from your osteopathic medical school; 2) Transcript of your medical school record, including board scores; 3) Three letters of recommendation from physicians familiar with your clinical and personal abilities; and 4) a recent photograph.

Alternatively, you may call and fax the St. Barnabas Hospital Osteopathic Medical Education office directly at:

Telephone: (718) 960-6608

Fax: (718) 960-3635

Email: paul_beyer@stbarnabas-ny.org

St. Barnabas Hospital

New York College of Osteopathic Medicine

of New York Institute of Technology

Initial Internship Application

Name:
Social Security #:	AOA#:
Current Address:
Permanent Address:
Current Phone:
Permanent Phone:
Fax Number:
Email:
Type of Internship Desired:	Rotating Internal Medicine Emergency Medicine Family Practice

Anticipated Residency(ies):	Undecided
Osteopathic College:
Dates Attended:	From: To:
National Board Scores:	Part 1 - Date Taken: Score: Percentile: Part 2 - Date Taken: Score: Percentile:
Previous Graduate Medical Education?	Yes No If Yes, Internship/Residency Type: Number of Years:
Member of AOA	Yes No