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
Domestic form forAnesthesia and Perioperative Care Kristine Beyer 
Domestic form forDermatology Tim Berger
Domestic form forEmergency Medicine Eric Silman
Domestic form forEpidemiology George Rutherford
Domestic form forFamily & Community Medicine Mike Potter
Domestic form forMedicine Cindy Lai
Domestic form forNeurology Vanja Douglas
Domestic form forNeurosurgery Manish Aghi
Domestic form forObstetrics & Gynecology Naomi Stotland
Domestic form forOphthalmology Jacque Duncan
Domestic form forOrthopaedic Surgery Nicole Schroeder
Domestic form forOtolaryngology-Head and Neck Surgery Anna Meyer
Domestic form forPathology Raga Ramachandran
Domestic form forPediatrics Tim Kelly
Domestic form forPsychiatry Descartes Li
Domestic form forRadiology Emily Webb
Domestic form forRadiation Oncology Penny Sneed
Domestic form forSurgery Nancy Ascher
Domestic form forUrology Kirsten Greene

 

International Courses and Clerkships

Department International Extramural Course Approval Form Instructor of Record
International form forAnesthesia and Perioperative Care Mark Rollins
International form forDermatology Tim Berger
International form forEmergency Medicine Eric Silman
International form forEpidemiology George Rutherford
International form forFamily & Community Medicine Norman Hearst
International form forMedicine Cindy Lai
International form forNeurology Vanja Douglas
International form forNeurosurgery Manish Aghi
International form forObstetrics & Gynecology Naomi Stotland
International form forOphthalmology Jacque Duncan
International form forOrthopaedic Surgery Nicole Schroeder
International form forOtolaryngology-Head and Neck Surgery Anna Meyer
International form forPathology Raga Ramachandran
International form forPediatrics Tim Kelly
International form forPsychiatry Descartes Li
International form forRadiology Emily Webb
International form forRadiation Oncology Penny Sneed
International form forSurgery Nancy Ascher
International form forUrology Kirsten Greene