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.

• Request for Extended Program: If you will be going on a Leave of Absence during your extended program, you will also need to complete a Leave of Absence Petition (available online via the Student Portal) and Readmission Application (download from the Registrar's website here.
• Letter of Support from the Dean (Minimum processing time is 2-3 weeks; Please note: It is required that you upload backup or additional documents necessary to process the letter.)
• Letter for Good Standing (Please note: It is required that you upload backup or additional documents necessary to process the letter.)
• MedEd Curricular Elective: This 4-week Career Launch elective is designed for students who have had a course cancelled due to COVID. Please note that you must have prior approval from your Career Launch Advisor and a faculty member before enrolling in this course.
• 196 Teaching Elective Credit
• 198 Supervised Study Credit
  • Sample 198 Form
• 198 Urology Form
• 150 Research Elective Credit
  • Sample 150 Form
  • Exemplary Sample - Research Elective Application, Section II

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 Report. 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, Dr. Mylo Schaaf must approve the experience before the TAA can be addressed.
2. If you are interested in doing an international clerkship, please contact Mylo Schaaf in order to review the international programs with whom we have pending TAAs, and to discuss previous student experiences at various programs. Dr. Schaaf 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 least 4 weeks prior to the start of the rotation.
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 Marcelo Furquim requesting this information. An evaluation link will be sent via MedHub to your off-site evaluator to complete. If you have questions, please contact Marcelo Furquim.

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 Mylo Schaff):
  • 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.
  • Global Health Elective Course Objectives Form is only required to be filled out together with your UCSF mentor if you are getting credit but not funding from UCSF, and is left with your UCSF mentor. If you are applying for funding from UCSF, it is part of your funding application.
• 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.
• Expense Reimbursement Request
• SOM Health Event Approval Form

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