medical education : Application
Online Application for Residency/Fellowship
Please note the following required documents must be sent to:
Firelands Regional Medical Center
OUHCOM CORE Office
Attn: Melodie Bayer, Manager, Medical Education
1912 Hayes Avenue
Sandusky, OH 44870
  • Residencies & Fellowships: Letter of recommendation from two osteopathic physicians (one of which should be the DME)
  • Fellowships only: Letter of recommendation from the residency program director
  • Personal statement
  • Curriculum vitae
  • Transcript from osteopathic school
  • Board scores
  • Dean’s letter
  • Copy of osteopathic diploma
  • Copy of internship diploma or letter from DME of expected graduation
  • Recent photo

Questions? Please contact Melodie Bayer, Manager, Medical Education at 419-557-7250 or e-mail bayer@ohio.edu.
Program Applying For:
Personal Data
Full Name:
Present Address:
Present Telephone:
Home Address:
Home Telephone:
E-mail Address:
Social Security #:
AOA#:
Race/Ethnicity (Optional):
Citizenship / Country:
Ohio License #:
Dates:
DEA License #:
Dates:
Educational and Professional Data
Premedical Education (School):
City:
State:
Degree:
Date of Graduation:
Medical Education (School):
City:
State:
Degree:
Date of Graduation:
Internship Program:
Hospital:
City:
State:
Dates:
Previous resident or postgraduate education:
Hospital:
City:
State:
Dates:
Have you had any lapse in training during medical school, internship or residency?
If yes, please explain:
 
Have you passed the COMLEX Examinations:  
COMLEX Part 1 Date:
State:
COMLEX Part 2 Date:
State:
COMLEX Part 3 Date:
State:
Have you taken/passed the USMLE Examination:  
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Firelands Regional Medical Center is a tobacco-free workplace. "Tobacco free" includes the use of any tobacco products. Pre-employment drug testing will include screening for tobacco product use, and prospective employees (including trainees) who test positive will not be hired.
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Learn about the rotations available through Firealnds Regional Medical Center's Medical Education department. LEARN MORE