Applicant Information Form

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

* Denotes required fields.

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All outdated listings will be removed July 1st of each year.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.