Applicant Information Form

for Urology Residency and Fellowship Training
(Maintained by the AUA Member Services)

Check all levels of Residency that apply

Personal Data

Present Address

Permanent Mailing Address

Nearest Relative or Individual Always Able to Contact You:

Medical School 1

Medical School 2

Undergraduate Institution

Previous Residency Training

All outdated listings will be removed July 1st of each year.
If you will to be listed again you must submit a new form.