OFFICE OF GRADUATE MEDICAL EDUCATION
UNSOM Forms
Please click on the link below that coordinates to your program location. Each link will give you important forms. All forms are fillable EXCEPT the VA - Las Vegas and certain forms in VA - Reno. For the VA- Las Vegas and VA - Reno will you need to print out the form and complete it. Please make sure all forms that are hand written for these two affiliates only are legible. This will reduce the need for you to fill them out again.
Please complete the forms before you print as no hand written forms will be accepted (except the two stated above). Please do not type signatures in signature blocks. Original signatures will be required. If you need assistance in completing the forms contact the Coordinator for your program. Coordinator's contact information is listed below and can be found on page 3 of your checklist and under Step I on the main GME webpage.
Program
|
Coordinator |
HR
|
UNSOM
|
Program
|
UNSOM Compliance
|
RRMC
|
UMC
|
VA Las Vegas
|
VA Reno
|
Acute Care Surgery |
Susan Thomas - (702) 671-2273 |
X |
X |
|
X |
|
X |
X |
|
Child Psychiatry |
Lisa LaGrone - (775) 682-8469 |
X |
X |
|
X |
X |
|
|
X |
Emergency Medicine |
Jennifer Michalski - (702) 383-7885 |
X |
X |
|
X |
|
X |
X |
|
FM Las Vegas |
Kathy Raymond - (702) 992-6875 |
X |
X |
X |
X |
|
X |
|
|
FM Reno |
Karen Selbach - (775) 682-8625 |
X |
X |
|
X |
X |
|
|
X |
OB Fellowship LV |
Kathy Raymond - (702) 992-6875 |
X |
X |
|
X |
|
X |
|
|
OB Fellowship Reno |
Karen Selbach - (775) 682-8625 |
X |
X |
|
X |
X |
|
|
X |
General Surgery |
Susan Thomas - (702) 671-2273 |
X |
X |
|
X |
|
X |
X |
|
Geriatrics |
Dominique Joseph - (775) 784-1801 |
X |
X |
|
X |
X |
|
|
X |
Hand and Microsurgery |
Susan Thomas - (702) 671-2273 |
X |
X |
|
X |
|
X |
X |
|
Int Med LV |
Jodi Greene - (702) 671-2358 |
X |
X |
X |
X |
|
X |
X |
|
Int Med Reno |
Brenda Goodwin - (775) 328-1429 |
X |
X |
|
X |
X |
|
|
X |
OB/GYN |
Carol Allen - (702) 671-2385 |
X |
X |
|
X |
|
X |
|
|
Pediatrics |
Carole Dapello - (702) 671-2236 |
X |
X |
|
X |
|
X |
X |
|
Plastic Surgery |
Susan Thomas - (702) 671-2273 |
X |
X |
|
X |
|
X |
X |
|
Psychiatry - Las Vegas |
Tami Abu-Hantash - (702) 671-6469 |
X |
X |
|
X |
|
X |
X |
|
Psychiatry - Reno |
Lisa LaGrone - (775) 784-4917 ext 243 |
X |
X |
|
X |
X |
|
|
X |
Sprts Md- LV |
Kathy Raymond - (702) 992-6875 |
X |
X |
|
X |
|
X |
|
|
Sprts Med -R |
Karen Selbach - (775) 682-8625 |
X |
X |
|
X |
|
X |
|
X |
