Fellowship Programs – Cook County Health

Salud del Condado de Cook fellowship programs further the education and training of physicians through rigorous clinical training, access to advanced research and broad experiences in the inpatient and outpatient setting.

Professional Education Offices have Moved!

We are now located next door at Cook County Health Edificio profesional

1950 W. Polk St.
Fifth Floor – Suite 5210 (West Wing)
Chicago, IL 60612
Rotator Check-in Hours: Monday through Friday from 8 am to 2 pm
HR ID Badge Hours: Monday through Friday from 8 am to 12 pm

Click aquí for sleep room reservations.

Becarios rotativos

All rotating residents/fellows must complete the following application.

Please complete the application annually per academic year.

Once you complete the application form below, you will be required to provide additional information. View this checklist for more information.

Notice: Proof of a flu shot given after 8/31 will be required as of 12/01 for any resident or fellow rotating at John H. Stroger, Jr. Hospital.

Questions? Please contact

Dahr Jackson
Department of Professional Education
(312) 864-0390
professionaled@cookcountyhealth.org

Name*
First Last
Dirección*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
MM
DD
YYYY
Email*
Phone*
Pager
Degree*
- DO
- Maryland
- DDS
- DMD
- DPM
NPI (National Provider Identifier)*
Illinois Medical License Number*
Illinois Medical License Look-Up
*If your medical license is not registered with Illinois, you will need a temporary Illinois state medical license. Contact Dahr Jackson, Department of Professional Education, at (312) 864-0390 or dnjackson@cookcountyhhs.org to apply. Applications take 4-6 months to process.
Medical School Information
Medical School Name*
Medical School City*
Medical School Country*
Graduation Date*
MM
DD
YYYY
ECFMG Issue Date*
MM
DD
YYYY
ECFMG Certificate*
Upload a copy of your ECFMG Certificate.
Residency/Fellowship Program
Institution Name*
Select your current institution's name. If not listed, select "Other".
Institution Name*
Enter your current institution's name.
Application for Elective Rotation*
Upload your completed "Application for Elective Rotation" form. Click the link Application for an Elective Rotation to download and complete the form.
Program Name*
(Example: Medicina Familiar, General Surgery, etc.)
Program Coordinator Name*
First Last
Program Coordinator Email*
Program Start Date*
MM
DD
YYYY
This is my 1st training program after medical/dental/podiatry school.*
- Yes
- No
Original Residency/Fellowship Program Name*
Post Graduate Level*
Select your post graduate level of when you started your current residency/fellowship program.
Rotations Requested
Number of Rotations Requested*
1) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
2) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
3) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
4) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
Electronic Signature
I have downloaded and read the Cook County Health Confidentiality Agreement and IT Security Rules of Behavior.*
(Cook County Health Confidentiality Agreement, IT Security Rules of Behavior)

I recognize I have a responsibility to protect patient health information;

I am aware of my obligations to report privacy violations;

I realize there are consequences for failure to protect patients health information up to and including termination/severance of our relationship.
- I will comply with the Cook County Health Confidentiality Agreement and IT Security Rules of Behavior.
I have downloaded and read the Cook County Health Badge/Security Card Release.*
(Badge Agreement)

If this card is lost or stolen, I agree to notify my coordinator immediately.

There is a $50 charge to replace the card.

If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.
- I agree to assume responsibility for the return of this card at the end of my rotation. I have read the entire Release letter and I fully understand and agree to it.

Name*
First Last
Dirección*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
MM
DD
YYYY
Email*
Phone*
Pager
Degree*
- DO
- Maryland
- DDS
- DMD
- DPM
NPI (National Provider Identifier)*
Illinois Medical License Number*
Illinois Medical License Look-Up
*If your medical license is not registered with Illinois, you will need a temporary Illinois state medical license. Contact Dahr Jackson, Department of Professional Education, at (312) 864-0390 or dnjackson@cookcountyhhs.org to apply. Applications take 4-6 months to process.
Medical School Information
Medical School Name*
Medical School City*
Medical School Country*
Graduation Date*
MM
DD
YYYY
ECFMG Issue Date*
MM
DD
YYYY
ECFMG Certificate*
Upload a copy of your ECFMG Certificate.
Residency/Fellowship Program
Institution Name*
Select your current institution's name. If not listed, select "Other".
Institution Name*
Enter your current institution's name.
Application for Elective Rotation*
Upload your completed "Application for Elective Rotation" form. Click the link Application for an Elective Rotation to download and complete the form.
Program Name*
(Example: Medicina Familiar, General Surgery, etc.)
Program Coordinator Name*
First Last
Program Coordinator Email*
Program Start Date*
MM
DD
YYYY
This is my 1st training program after medical/dental/podiatry school.*
- Yes
- No
Original Residency/Fellowship Program Name*
Post Graduate Level*
Select your post graduate level of when you started your current residency/fellowship program.
Rotations Requested
Number of Rotations Requested*
1) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
2) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
3) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
4) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
Electronic Signature
I have downloaded and read the Cook County Health Confidentiality Agreement and IT Security Rules of Behavior.*
(Cook County Health Confidentiality Agreement, IT Security Rules of Behavior)

I recognize I have a responsibility to protect patient health information;

I am aware of my obligations to report privacy violations;

I realize there are consequences for failure to protect patients health information up to and including termination/severance of our relationship.
- I will comply with the Cook County Health Confidentiality Agreement and IT Security Rules of Behavior.
I have downloaded and read the Cook County Health Badge/Security Card Release.*
(Badge Agreement)

If this card is lost or stolen, I agree to notify my coordinator immediately.

There is a $50 charge to replace the card.

If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.
- I agree to assume responsibility for the return of this card at the end of my rotation. I have read the entire Release letter and I fully understand and agree to it.

Name*
First Last
Dirección*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
MM
DD
YYYY
Email*
Phone*
Pager
Degree*
- DO
- Maryland
- DDS
- DMD
- DPM
NPI (National Provider Identifier)*
Illinois Medical License Number*
Illinois Medical License Look-Up
*If your medical license is not registered with Illinois, you will need a temporary Illinois state medical license. Contact Dahr Jackson, Department of Professional Education, at (312) 864-0390 or dnjackson@cookcountyhhs.org to apply. Applications take 4-6 months to process.
Medical School Information
Medical School Name*
Medical School City*
Medical School Country*
Graduation Date*
MM
DD
YYYY
ECFMG Issue Date*
MM
DD
YYYY
ECFMG Certificate*
Upload a copy of your ECFMG Certificate.
Residency/Fellowship Program
Institution Name*
Select your current institution's name. If not listed, select "Other".
Institution Name*
Enter your current institution's name.
Application for Elective Rotation*
Upload your completed "Application for Elective Rotation" form. Click the link Application for an Elective Rotation to download and complete the form.
Program Name*
(Example: Medicina Familiar, General Surgery, etc.)
Program Coordinator Name*
First Last
Program Coordinator Email*
Program Start Date*
MM
DD
YYYY
This is my 1st training program after medical/dental/podiatry school.*
- Yes
- No
Original Residency/Fellowship Program Name*
Post Graduate Level*
Select your post graduate level of when you started your current residency/fellowship program.
Rotations Requested
Number of Rotations Requested*
1) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
2) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
3) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
4) Department/Division*
Rotation Name*
Start Date*
MM
DD
YYYY
End Date*
MM
DD
YYYY
Electronic Signature
I have downloaded and read the Cook County Health Confidentiality Agreement and IT Security Rules of Behavior.*
(Cook County Health Confidentiality Agreement, IT Security Rules of Behavior)

I recognize I have a responsibility to protect patient health information;

I am aware of my obligations to report privacy violations;

I realize there are consequences for failure to protect patients health information up to and including termination/severance of our relationship.
- I will comply with the Cook County Health Confidentiality Agreement and IT Security Rules of Behavior.
I have downloaded and read the Cook County Health Badge/Security Card Release.*
(Badge Agreement)

If this card is lost or stolen, I agree to notify my coordinator immediately.

There is a $50 charge to replace the card.

If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.
- I agree to assume responsibility for the return of this card at the end of my rotation. I have read the entire Release letter and I fully understand and agree to it.

Salud del Condado de Cook fellowship programs further the education and training of physicians through rigorous clinical training, access to advanced research and broad experiences in the inpatient and outpatient setting.

Professional Education Offices have Moved!

We are now located next door at Cook County Health Edificio profesional

1950 W. Polk St. Fifth Floor – Suite 5210 (West Wing) Chicago, IL 60612 Rotator Check-in Hours: Monday through Friday from 8 am to 2 pmHR ID Badge Hours: Monday through Friday from 8 am to 12 pm

Click aquí for sleep room reservations.

Becarios rotativos

All rotating residents/fellows must complete the following application.

Please complete the application annually per academic year.

Once you complete the application form below, you will be required to provide additional information. View this checklist for more information.

Notice: Proof of a flu shot given after 8/31 will be required as of 12/01 for any resident or fellow rotating at John H. Stroger, Jr. Hospital.

Questions? Please contact

Medical School Information

Residency/Fellowship Program

Rotations Requested

Electronic Signature

(Badge Agreement) If this card is lost or stolen, I agree to notify my coordinator immediately. There is a $50 charge to replace the card. If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.

Medical School Information

Residency/Fellowship Program

Rotations Requested

Electronic Signature

(Badge Agreement) If this card is lost or stolen, I agree to notify my coordinator immediately. There is a $50 charge to replace the card. If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.

Medical School Information

Residency/Fellowship Program

Rotations Requested

Electronic Signature

(Badge Agreement) If this card is lost or stolen, I agree to notify my coordinator immediately. There is a $50 charge to replace the card. If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.

1950 W. Polk St.
Fifth Floor – Suite 5210 (West Wing)
Chicago, IL 60612
Rotator Check-in Hours: Monday through Friday from 8 am to 2 pm
HR ID Badge Hours: Monday through Friday from 8 am to 12 pm

(Badge Agreement)

If this card is lost or stolen, I agree to notify my coordinator immediately.

There is a $50 charge to replace the card.

If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.

(Badge Agreement)

If this card is lost or stolen, I agree to notify my coordinator immediately.

There is a $50 charge to replace the card.

If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.

(Badge Agreement)

If this card is lost or stolen, I agree to notify my coordinator immediately.

There is a $50 charge to replace the card.

If I fail to return this card my institutional coordinator will be notified and a Fee will be sent to your institution.