Pre-Application Form

Thank you for your interest in our CAST program. Please complete the pre-application form below to begin the process of becoming a CAST trainee. Please be advised that the full application and onboarding process can take anywhere from 3-5 months to complete. Once the completed pre-application is received, the CAST Coordinator will be in touch.

First name

Last name

Phone numberFormat: ###-###-####

Information about the clinic/hospital at which you work

Name of clinic/hospital

Address

City

State

Zip code

Training Background

Which program are you interested in?

Which Pathway are you interested in?

When and where did you complete your training?

When and where did you complete your fellowship training? In what field?

Please list all laparoscopic procedures that you have done.

What type and how many cases have you done?

What do you hope to gain from this program? (Please be specific.)

When would you like to start this program?(Please note that due to our lengthy application process, we will need a minimum of 12 weeks before your training can begin)

How long would you like to train (1-8 weeks)?

How did you hear about this program?

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Coming to a Cleveland Clinic location?