ࡱ> XZW\  bjbj 3Xjbjb,rxxx8+2   <<<$] #xV@"VV  ***V^R x *V**V"* vbj*0+*#x#*#x*l<L6*,l<<<<<<+VVVV#<<<<<<<<<B :  Department of Ophthalmology Elective Form Resident: ___________________________ Start Date: __________________________ End Date: _______________________ Preceptor(s): ____________________________________________________________ University Affiliation: _____________________________________________________ What type of elective is this? Clinical: Yes No Research: Yes No Clinical Objectives: 1. 2. 3. 4. Research Objectives: 1. 2. 3. 4. Resident Signature: _____________________________ Date: _________________ Program Director: ______________________________ Date: __________________ Please submit this completed form to the Program Administrator 10 weeks prior to commencement of your elective.      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