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ATTACH RECENT PHOTOGRAPH UAB HOSPITAL/UNIVERSITY OF ALABAMA SCHOOL OF MEDICINE APPLICATION FOR GRADUATE MEDICAL EDUCATION Please type or print Date of Application Match if applicable Mon Day Year Name Social Sec. No. Last First Middle Application is made for graduate medical education in the specialty of beginning Mon/Year PGY-4 at postgraduate year check one PGY-5 PGY-6 PGY-1 PGY-2 PGY-3 Zip Country if other than USA PGY-7 or other list Present .

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