Resident Request for Affiliation Agreement

Please complete this form to initiate an affiliation agreement for resident rotations to Virginia Mason from another facility or from Virginia Mason to another facility. The Graduate Medical Education Department will contact you to schedule a telephone intake appointment upon receipt of this information.

• For Virginia Mason requestors, the requestor must be a Virginia Mason Residency Program Director, faculty or GME Director.
• If another health care facility is requesting a rotation, requestor must be a GME Director or Residency Program Director for that facility.