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Visiting Resident Medical Toxicology Rotation - Application

To apply for the toxicology rotation program at the NYC Poison Control Center, complete and submit the form below.

You also must submit:

A Non-disclosure Agreement
A letter from your home institution (PDF format) on official letterhead stating you are in good standing and will have your salary and malpractice coverage provided
A photo (school or government ID preferred)

You will receive specific instructions on how to provide this information after you submit the application form. If your institution cannot provide a letter confirming malpractice coverage, or if you have any other questions or concerns, email nycpcctoxrotation@health.nyc.gov.

Application Form

Provide your contact details and your first and second choice start dates for a rotation. We will try to give you your first choice, but we cannot guarantee availability. Choosing a session start date does not mean you will be registered for that date. You must apply at least one month – but not more than three months – before your preferred session start date.

* Indicates required fields

Applicant Information

First Name*

Last Name*

Email*

Affiliation* Please type full name of hospital or medical center, no abbreviations

Address*

City*

State/County/Province*

ZIP/Postal Code*

Country*

Specialty*

What year of training are you in?*

Applicant's Program Coordinator's or Program Director's Information

Program Coordinator First Name*

Program Coordinator Last Name*

Program Coordinator/Director Email*

Rotation Session Information

Rotation Length* (We recommend the four-week rotation.)

Four-week rotation

Two-week rotation

Choose a preferred rotation session start date*
(All rotation sessions begin on Mondays. There are no start dates on weeks with a Monday government holiday.)

Choose a SECOND choice rotation session start date should your first choice be unavailable.

Agreements (Must select all)

I attest that I have reviewed the PCC rotation description and understand the rotation responsibilities of daily call-backs and completing a project presentation.*

Yes

I understand there is an attendance requirement for the successful completion of the toxicology rotation at the NYC Poison Control Center. I understand that I must send a written email notification to nycpcctoxrotation@health.nyc.gov for all absences.*

Yes

I understand that the email I provided above will be used for all future communications regarding the NYC Poison Control Center. I understand that my email and contact information will not be shared with outside parties.*

Yes

How did you hear about the rotation?*

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