Please indicate that you have attached the following to your application:
Refresher/Re-entry Application Packet must include:
Copy of your Medical Degree certificate (in English or English translation)
Curriculum vitae
Head shot Photo
$100 (Non-Refundable) Application Fee
Drexel Medicine® Physician Refresher/Re-Entry Course
Admissions Application for:
Medical Update Curriculum and Assessment
Online Clinical Skills Curriculum and Assessment
Targeted Remediation and Training: Medical Documentation
These activities are distance-learning modules that 1) provide up-to-date general medical and subspecialty
information needed for clinical practice, 2) improve clinical reasoning and communication skills and 3) sharpen
medical documentation and coding skills. These activities, which can be taken independently or in sequence, will
reinforce your knowledge, skills and help you identify areas for additional selective study. Tuition ranges from
$7,500 to $8,500 per activity.
Online Medical Update Didactic Curriculum
Check all that apply:
Online Clinical Skills and Assessment
Targeted Remediation and Training: Medical Documentation
Name:
Last
First
MI
Degree
Age (Year of Birth)
Address:
Street Address
State
City
Home Phone:
Email Address:
Cell Phone:
Primary Employer
Medical School
Zip Code
Current Position
Location
Graduation Year
Did you complete an internship?
If yes, where
Dates of internship From:
To:
Did you complete a residency?
If yes, where
Dates of residency From:
To:
Residency Field
Years away from clinic practice
If applicable, write a summary describing why you are not currently practicing and what you have been doing since you left
clinical practice.
What are your specific goals or the two most important things you hope to gain by participating in the activity?
What is your residency status? (for data collection only)
Non US citizens, what is your country of citizenship:
Do you have a preferable start date?
If so, when?
Do you have a current active licesnse in the US?
Are you licensed to practice outside of the U.S.?
If yes, what state?
If yes, what country(s)
What was the date of your last board certification?
What specialty
When will it expire?
What is your primary language?
How were you referred to this program?
If a report is required at the end of the course, who will receive the report
Due Date
Return with a copy of your medical degree (in English or English translation), your CV, head shot photo, and $100 (nonrefundable) application fee.
If paying application fee by credit card:
Credit Card type
Credit Card Number
Expiration Date
Signature
(Do not email application with credit card information)
Forward application by mail or fax to:
Drexel University College of Medicine
Office of Continuing Medical Education
1505 Race Street, 11th Floor
Philadelphia, PA 19102
Phone # 215.762.2580 Fax # 215.762.2589
Email cynthia.johnson@drexelmed.edu
Before the final admissions decision, you may be contacted by telephone to review your application and
discuss your training priorities.
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ADMISSION DECISION
Admitted
Denied
Start Date______________________________________________
Signature/date : _________________________________________________________________________
Comments :____________________________________________________________________________
Assigned Department/Division/Speciality:____________________________________________________