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Medical Education
Medical Student Education

Extramural Course or Clerkship Application Forms

Instructions

  1. If you haven’t already activated your UCSF DocuSign account, please follow these instructions:
    • Login to MyAccess: https://myaccess.ucsf.eduhttps://myaccess.ucsf.edu
    • Scroll down to “DocuSign – UCSF” and click on the link to DocuSign. This will initiate creating your account if you don’t already have one (the account creation takes a minute or so).
    • Once signed in, you will see a status box, as well as help resources should you want more info about DocuSign.
  2. Select the link below for the corresponding department's extramural course form (Domestic OR International).
  3. Follow the instructions for completing the form at least 4 weeks prior to the start of the rotation. Please note that you are required to attach a description of the rotation. Your form will be sent electronically to the listed Instructor of Record. 
  4. When the course is approved, you will receive an email confirmation. If you have attached documents that require a seal, please come by S-245 to pick up your documents after you have received a COMPLETED application email notification.

For any questions related to the extramural course approval form, please contact Cha Viloria.

Domestic Courses and Clerkships

Department Domestic Extramural Course Approval Form Instructor of Record
Anesthesia and Perioperative Care Kristine Beyer 
Dermatology Tim Berger
Emergency Medicine Eric Silman
Epidemiology George Rutherford
Family & Community Medicine Mike Potter
Medicine Cindy Lai
Neurology Vanja Douglas
Neurosurgery Mike McDermott
Obstetrics & Gynecology Naomi Stotland
Ophthalmology Jacque Duncan
Orthopaedic Surgery Mohammad Diab
Otolaryngology-Head and Neck Surgery Anna Meyer
Pathology Raga Ramachandran
Pediatrics Tim Kelly
Psychiatry Descartes Li
Radiology Emily Webb
Radiation Oncology Penny Sneed
Surgery Nancy Ascher
Urology Kirsten Greene

 

International Courses and Clerkships

Department International Extramural Course Approval Form Instructor of Record
Anesthesia and Perioperative Care Mark Rollins
Dermatology Tim Berger
Emergency Medicine Eric Silman
Epidemiology George Rutherford
Family & Community Medicine Norman Hearst
Medicine Cindy Lai
Neurology Vanja Douglas
Neurosurgery Mike McDermott
Obstetrics & Gynecology Naomi Stotland
Ophthalmology Jacque Duncan
Orthopaedic Surgery Mohammad Diab
Otolaryngology-Head and Neck Surgery Anna Meyer
Pathology Raga Ramachandran
Pediatrics Tim Kelly
Psychiatry Descartes Li
Radiology Emily Webb
Radiation Oncology Penny Sneed
Surgery Nancy Ascher
Urology Kirsten Greene

 

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