Hooding Request

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The Convocation "Hooding Ceremony" will take place June 1, 2005 , 8:00 p.m. You may choose any physician (MD or DO) or any current faculty member of The College of Medicine to bestow your hood. Please let us know your choices without informing the physicians. Drs. Linda Stone and Judith Westman will send a letter requesting that he/she place your hood. Please provide as much information as possible regarding the physician(s) you are selecting so that contacting them is made easier. It is not a requirement that you choose a physician to hood you. If you do not wish to choose someone please write "Dean's Staff' as your first choice and return the form. You will be informed at a later date who, of your preferred choices, will be hooding you.

First Choice

Physician's Full Name, MD or DO, or Faculty member's full name:

Specialty/Department:

Street Address:

City, State and Zip Code:

Phone Number:

E-mail address (if available):

Second Choice

Physician's Full Name, MD or DO, or Faculty member's full name:

Specialty/Department:

Street Address:

City, State and Zip Code:

Phone Number:

E-mail address (if available):

Third Choice

Physician's Full Name, MD or DO, or Faculty member's full name:

Specialty/Department:

Street Address:

City, State and Zip Code:

Phone Number:

E-mail address (if available):

Check here if you are not attending the Hooding Ceremony.

If you have any questions, call Michelle Krichbaum at (614) 688-3104 or e-mail Michelle.Krichbaum@osumc.edu. Thank you.