Academic Forms

Forms that require the Dean's signature should be turned in to S-245. Processing time for forms is 5-7 business days. Letters are completed within 2-3 weeks. You will be contacted by email when your form/letter is ready to be picked up.

Extramural Course or Clerkship Application 

1. 1 - 3 months (if not more) before the rotation, check to see if the institution is listed in the Training Affiliation Agreement. If it is not, contact Valerie Jones to see if a TAA can be worked out for the location. Please note that for international rotations, the School of Medicine must approve the experience before the TAA can be addressed.
2. If you are interested in doing an international clerkship, please contact Michael Lipnick, MD in order to review the international programs with whom we have pending TAAs, and to discuss previous student experiences at various programs. Dr. Lipnick will need to sign off on the electronic Application for Extramural Course or Clerkship form if you are doing an international rotation.
3. Submit the Extramural Course or Clerkship Approval Form via DocuSign at the same time you apply for the rotation.If you are applying through the AAMC VSLO portal, we cannot release the application to the school until we have your Extramural Form.
4. To receive an evaluation for your away rotation, you must provide your off-site faculty supervisor's name and email address. You will receive an email from Will Stevens requesting this information. An evaluation link will be sent via MedHub to your off-site evaluator to complete. If you have questions, please contact Will Stevens.

Away Rotation Information

• The International Emergency Packet and the International Student Travel Approval form: These forms are required of all students requesting credit or funding for time spent abroad doing clerkships or research work.
  • The International Emergency Packet must be completed.
  • The Student International Travel form must be completed, approved, and signed.
    • For international rotations: both forms noted above must be attached to the Extramural Course or Clerkship Approval form for submission.
    • For research: both forms noted above must be attached to your Deep Explore/Yearlong application or your Summer Explore funding application or your Research Elective Approval form (150.01/105.02).
• Additional forms required for international clerkships (if questions, contact Travis Pentz):
  • Request for Credit: Extramural Course or Clerkship Approval Form (Use the international form for the corresponding UCSF department; follow submission instructions on form).
  • The Global Health Student Evaluation Form must be downloaded and hand-carried abroad to give to your foreign preceptor. Bring back the completed evaluation form and give it to your UCSF mentor who is arranging credit for you.
• Additional forms required for international research:
  • Request for Credit: 150 Research Elective Credit (Follow submission instructions on the form.) Note this form must be submitted with the International Emergency Packet and the Student International Travel form. See above.

• Request for Conference Travel Funds – One-time award for students giving an oral or poster presentation at a conference. Applications must be submitted at least one month prior to travel.

Click here to access Registrar Forms. All forms are also available at the Office of the Registrar in MU-200W.