We'd like to learn more about you
...because you're here to be become an outstanding physician and we're here to help get you there. As part of our mentorship program, we'd like to gather some information that will help us pair you with a mentor during internship. Don't worry, nothing is set in stone. We know interests and future plans change, and you may seek additional mentors. But this will give us a start.
Hobbies and interests: (optional)
Important things in your life: (optional)
High school of graduation: (optional; for informational purposes)
Career Plans: Which career paths are you most interested in?
Now, let's consider some factors for scheduling
When do you expect this? Please add any additional comments.
And finally, let's discuss some specific scheduling requests
Ophthalmology Track
Ophtho track interns will each be assigned to a 6-week Ophtho block at Olive View and a 6-week Ophtho block at the West LA VA. When not on Ophtho block, your schedule will typically follow the 4+1 schedule with Internal Medicine.
Ophtho rotations and Ambulatory blocks (outpatient "+1" weeks) will be pre-scheduled according to the available options. Other clinical rotations (inpatient and medicine subspecialties) and vacation will be assigned thereafter. Rotations must fit into the two-week blocks outlined in black.
Ophthalmology Block Schedule Options
Instructions: Look at the available Ophtho block schedule options . Select up to 3 preferred schedules, from most to least preferred.
—Please choose an option— Option A Option B Option C Option D Option E Option F Option G
—Please choose an option— Option A Option B Option C Option D Option E Option F Option G
—Please choose an option— Option A Option B Option C Option D Option E Option F Option G
For Internal Medicine, we will continue with our 4+1 schedule, meaning your schedule will follow the pattern of a four-week rotation (or 2 two-week rotations) followed by one week of Ambulatory Medicine ("+1" or "Amb week") every fifth week.
These rotations will follow the block schedule that you can view here . The chart identifies the block starting dates for the entire academic year. The blocks generally start on Thursday and end on Wednesday, with the exception being the first and last blocks of the academic year.
Block Schedule Dates for 2026-2027
Vacation Request
Use this section to place your vacation requests. Each housestaff receives 4 weeks of vacation per year, split into 2 two-week blocks. Vacation blocks cannot interfere with +1 Ambulatory blocks.
Please note that the number of vacationers during any given block will be limited, so please indicate if certain dates are very important (e.g. you're getting married). Thanksgiving, Christmas, New Years, and Memorial Day are very popular, but only a small number will get vacation during these times. Therefore we cannot guarantee vacation requests, but we will do our best to accommodate.
Instructions: Choose your vacation preferences based on the available options. Available blocks are subject to change. If you do not have specific vacation dates in mind, choose "Best Available" and we will schedule vacation blocks for you, usually spread apart as much as possible. Vacation blocks should not interfere with Ophtho or +1 Amb blocks.
—Please choose an option— Best Available P Weeks 1-2: 6/24/26 - 7/8/26 P Weeks 3-4: 7/9/26 - 7/22/26 P Weeks 4-5: 7/16/26 - 7/29/26 P Weeks 16-17: 10/8/26 - 10/21/26 P Weeks 19-20: 10/29/26 - 11/11/26 P Weeks 21-22: 11/12/26 - 11/25/26 P Weeks 23-24: 11/26/26 - 12/9/26 P Weeks 27-28: 12/24/26 - 1/6/27 P Weeks 35-36: 2/18/27 - 3/3/27 P Weeks 36-37: 2/25/27 - 3/10/27 P Weeks 41-42: 4/1/27 - 4/14/27 P Weeks 46-47: 5/6/27 - 5/19/27 P Weeks 50-51: 6/3/27 - 6/16/27
—Please choose an option— Best Available P Weeks 1-2: 6/24/26 - 7/8/26 P Weeks 3-4: 7/9/26 - 7/22/26 P Weeks 4-5: 7/16/26 - 7/29/26 P Weeks 16-17: 10/8/26 - 10/21/26 P Weeks 19-20: 10/29/26 - 11/11/26 P Weeks 21-22: 11/12/26 - 11/25/26 P Weeks 23-24: 11/26/26 - 12/9/26 P Weeks 27-28: 12/24/26 - 1/6/27 P Weeks 35-36: 2/18/27 - 3/3/27 P Weeks 36-37: 2/25/27 - 3/10/27 P Weeks 41-42: 4/1/27 - 4/14/27 P Weeks 46-47: 5/6/27 - 5/19/27 P Weeks 50-51: 6/3/27 - 6/16/27
—Please choose an option— Best Available P Weeks 1-2: 6/24/26 - 7/8/26 P Weeks 3-4: 7/9/26 - 7/22/26 P Weeks 4-5: 7/16/26 - 7/29/26 P Weeks 16-17: 10/8/26 - 10/21/26 P Weeks 19-20: 10/29/26 - 11/11/26 P Weeks 21-22: 11/12/26 - 11/25/26 P Weeks 23-24: 11/26/26 - 12/9/26 P Weeks 27-28: 12/24/26 - 1/6/27 P Weeks 35-36: 2/18/27 - 3/3/27 P Weeks 36-37: 2/25/27 - 3/10/27 P Weeks 41-42: 4/1/27 - 4/14/27 P Weeks 46-47: 5/6/27 - 5/19/27 P Weeks 50-51: 6/3/27 - 6/16/27
—Please choose an option— Best Available P Weeks 1-2: 6/24/26 - 7/8/26 P Weeks 3-4: 7/9/26 - 7/22/26 P Weeks 4-5: 7/16/26 - 7/29/26 P Weeks 16-17: 10/8/26 - 10/21/26 P Weeks 19-20: 10/29/26 - 11/11/26 P Weeks 21-22: 11/12/26 - 11/25/26 P Weeks 23-24: 11/26/26 - 12/9/26 P Weeks 27-28: 12/24/26 - 1/6/27 P Weeks 35-36: 2/18/27 - 3/3/27 P Weeks 36-37: 2/25/27 - 3/10/27 P Weeks 41-42: 4/1/27 - 4/14/27 P Weeks 46-47: 5/6/27 - 5/19/27 P Weeks 50-51: 6/3/27 - 6/16/27
Comments:
Based on your vacation requests, you will be assigned to a Pod, which determines the assignment to +1 Amb week for the entire year and residency.
Instructions: If you have specific vacation preferences, look at the available vacation blocks below. Then choose the group that best matches your preferences. Available blocks are subject to change. If you do not have specific vacation dates in mind, choose "Best Available" and we will schedule vacation blocks for you. We usually find vacation blocks that are spread apart.
Group
Vacation Block Options
Group A
Weeks 1-2: 6/24/2026 - 7/8/2026
Weeks 3-4: 7/9/2026 - 7/22/2026
Weeks 6-7: 7/30/2026 - 8/12/2026
Weeks 8-9: 8/13/2026 - 8/26/2026
Weeks 11-12: 9/3/2026 - 9/16/2026
Weeks 13-14: 9/17/2026 - 9/30/2026
Weeks 21-22: 11/12/2026 - 11/25/2026
Weeks 23-24: 11/26/2026 - 12/9/2026
Weeks 31-32: 1/21/2027 - 2/3/2027
Weeks 41-42: 4/1/2027 - 4/14/2027
Weeks 43-44: 4/15/2027 - 4/28/2027
Weeks 46-47: 5/6/2027 - 5/19/2027
Group B
Weeks 2-3: 7/2/2026 - 7/15/2026
Weeks 3-4: 7/9/2026 - 7/22/2026
Weeks 4-5: 7/16/2026 - 7/29/2026
Weeks 7-8: 8/6/2026 - 8/19/2026
Weeks 14-15: 9/24/2026 - 10/7/2026
Weeks 17-18: 10/15/2026 - 10/28/2026
Weeks 19-20: 10/29/2026 - 11/11/2026
Weeks 24-25: 12/3/2026 - 12/16/2026
Weeks 29-30: 1/7/2027 - 1/20/2027
Weeks 32-33: 1/28/2027 - 2/10/2027
Weeks 39-40: 3/18/2027 - 3/31/2027
Weeks 44-45: 4/22/2027 - 5/5/2027
Group C
Weeks 5-6: 7/23/2026 - 8/5/2026
Weeks 8-9: 8/13/2026 - 8/26/2026
Weeks 18-19: 10/22/2026 - 11/4/2026
Weeks 23-24: 11/26/2026 - 12/9/2026
Weeks 25-26: 12/10/2026 - 12/23/2026
Weeks 28-29: 12/31/2026 - 1/13/2027
Weeks 33-34: 2/4/2027 - 2/17/2027
Weeks 40-41: 3/25/2027 - 4/7/2027
Weeks 43-44: 4/15/2027 - 4/28/2027
Weeks 48-49: 5/20/2027 - 6/2/2027
Group D
Weeks 1-2: 6/24/2026 - 7/8/2026
Weeks 6-7: 7/30/2026 - 8/12/2026
Weeks 9-10: 8/20/2026 - 9/2/2026
Weeks 11-12: 9/3/2026 - 9/16/2026
Weeks 16-17: 10/8/2026 - 10/21/2026
Weeks 19-20: 10/29/2026 - 11/11/2026
Weeks 21-22: 11/12/2026 - 11/25/2026
Weeks 26-27: 12/17/2026 - 12/30/2026
Weeks 31-32: 1/21/2027 - 2/3/2027
Weeks 34-35: 2/11/2027 - 2/24/2027
Weeks 41-42: 4/1/2027 - 4/14/2027
Weeks 44-45: 4/22/2027 - 5/5/2027
Weeks 46-47: 5/6/2027 - 5/19/2027
Weeks 51-52: 6/10/2027 - 6/23/2027
Group E
Weeks 2-3: 7/2/2026 - 7/15/2026
Weeks 5-6: 7/23/2026 - 8/5/2026
Weeks 6-7: 7/30/2026 - 8/12/2026
Weeks 7-8: 8/6/2026 - 8/19/2026
Weeks 10-11: 8/27/2026 - 9/9/2026
Weeks 11-12: 9/3/2026 - 9/16/2026
Weeks 12-13: 9/10/2026 - 9/23/2026
Weeks 15-16: 10/1/2026 - 10/14/2026
Weeks 17-18: 10/15/2026 - 10/28/2026
Weeks 20-21: 11/5/2026 - 11/18/2026
Weeks 25-26: 12/10/2026 - 12/23/2026
Weeks 30-31: 1/14/2027 - 1/27/2027
Weeks 35-36: 2/18/2027 - 3/3/2027
Weeks 37-38: 3/4/2027 - 3/17/2027
Weeks 50-51: 6/3/2027 - 6/16/2027
First Set of Vacation Preferences
Select the group, then up to 4 options. We will try to assign two vacation blocks among this first set of preferences.
Group: —Please choose an option— Best Available Group A Group B Group C Group D Group E
Option 1: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 2: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 3: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 4: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 1: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 2: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 3: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 4: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 1: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 2: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 3: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 4: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 1: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 2: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 3: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 4: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 1: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Option 2: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Option 3: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Option 4: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Other/Comments:
Second Set of Vacation Preferences
Select a different group than above, then up to 4 options. We will use this set if we cannot accommodate your first set of preferences.
Group: —Please choose an option— Group A Group B Group C Group D Group E
Option 1: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 2: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 3: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 4: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 13-14: 9/17/2026 - 9/30/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 46-47: 5/6/2027 - 5/19/2027
Option 1: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 2: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 3: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 4: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 3-4: 7/9/2026 - 7/22/2026 Weeks 4-5: 7/16/2026 - 7/29/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 14-15: 9/24/2026 - 10/7/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 24-25: 12/3/2026 - 12/16/2026 Weeks 29-30: 1/7/2027 - 1/20/2027 Weeks 32-33: 1/28/2027 - 2/10/2027 Weeks 39-40: 3/18/2027 - 3/31/2027 Weeks 44-45: 4/22/2027 - 5/5/2027
Option 1: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 2: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 3: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 4: —Please choose an option— Best Available Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 8-9: 8/13/2026 - 8/26/2026 Weeks 18-19: 10/22/2026 - 11/4/2026 Weeks 23-24: 11/26/2026 - 12/9/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 28-29: 12/31/2026 - 1/13/2027 Weeks 33-34: 2/4/2027 - 2/17/2027 Weeks 40-41: 3/25/2027 - 4/7/2027 Weeks 43-44: 4/15/2027 - 4/28/2027 Weeks 48-49: 5/20/2027 - 6/2/2027
Option 1: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 2: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 3: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 4: —Please choose an option— Best Available Weeks 1-2: 6/24/2026 - 7/8/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 9-10: 8/20/2026 - 9/2/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 16-17: 10/8/2026 - 10/21/2026 Weeks 19-20: 10/29/2026 - 11/11/2026 Weeks 21-22: 11/12/2026 - 11/25/2026 Weeks 26-27: 12/17/2026 - 12/30/2026 Weeks 31-32: 1/21/2027 - 2/3/2027 Weeks 34-35: 2/11/2027 - 2/24/2027 Weeks 41-42: 4/1/2027 - 4/14/2027 Weeks 44-45: 4/22/2027 - 5/5/2027 Weeks 46-47: 5/6/2027 - 5/19/2027 Weeks 51-52: 6/10/2027 - 6/23/2027
Option 1: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Option 2: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Option 3: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Option 4: —Please choose an option— Best Available Weeks 2-3: 7/2/2026 - 7/15/2026 Weeks 5-6: 7/23/2026 - 8/5/2026 Weeks 6-7: 7/30/2026 - 8/12/2026 Weeks 7-8: 8/6/2026 - 8/19/2026 Weeks 10-11: 8/27/2026 - 9/9/2026 Weeks 11-12: 9/3/2026 - 9/16/2026 Weeks 12-13: 9/10/2026 - 9/23/2026 Weeks 15-16: 10/1/2026 - 10/14/2026 Weeks 17-18: 10/15/2026 - 10/28/2026 Weeks 20-21: 11/5/2026 - 11/18/2026 Weeks 25-26: 12/10/2026 - 12/23/2026 Weeks 30-31: 1/14/2027 - 1/27/2027 Weeks 35-36: 2/18/2027 - 3/3/2027 Weeks 37-38: 3/4/2027 - 3/17/2027 Weeks 50-51: 6/3/2027 - 6/16/2027
Other/Comments:
Prioritize your requests
Arrange the requests above from most to least important (okay to leave blanks) .
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Clinic Site for Primary Care Continuity RR Gen Med Wards VA Gen Med Wards First Vacation Preference Set: Option 1 First Vacation Preference Set: Option 2 First Vacation Preference Set: Option 3 First Vacation Preference Set: Option 4 Second Vacation Preference Set: Option 1 Second Vacation Preference Set: Option 2 Second Vacation Preference Set: Option 3 Second Vacation Preference Set: Option 4
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
—Please choose an option— Ophtho Schedule Preference 1 Ophtho Schedule Preference 2 Ophtho Schedule Preference 3 Vacation Option 1 Vacation Option 2 Vacation Option 3 Vacation Option 4 RR Gen Med Wards VA Gen Med Wards
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