Family Medicine Year 4 Electives Request Form

Please fill out the below form to request year 4 electives in Family Medicine.

  • *This form is only open to Western students. If you are a visiting student, please visit the Visiting Student Elective website.
  • Once your form is submitted, please allow 4-6 weeks for confirmation by email from the Program Coordinator.
  • Forms will not be processed until after April 1.
  • A copy of your submission will be sent to you by email for your records.
  • Please do not include requests for: Windsor or Sports Medicine.

Please Note: The electives request form will become available March 1

After March 1, 9:00 a.m. Click Here to Submit your Year 4 Elective Request