Academic Forms

School of Medicine 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.

Academic Forms

• 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.)
• 196 Teaching Elective Credit
• 198 Supervised Study Credit
  • Sample 198 Form
• 150 Research Elective Credit
  • Sample 150 Form
  • Exemplary Sample - Research Elective Application, Section II

• 199B Application for Step 2 study credit  The 4-week IDS 199B Step 2 CK Advanced Independent Study elective is designed for students with a demonstrated academic need for extended study time to obtain a passing Step 2 score. Examples include previous acceptance into the PILLAR program; an academic-based delayed clerkship start; a non-passing score on one or more core clerkship shelf exams; or a previous non-passing Step 1 or Step 2 score, or just-passing Step 1 score.

Extramural Clerkship Instructions (Domestic and International)

1. 6-9 months 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.

International Forms

• International Emergency Packet: These forms are required of all students requesting credit for time spent abroad doing clerkships or research work.
  • The International Packet must be accessed, completed and uploaded at this link:  International Experiences iROCKET course. If you encounter any issues, please contact Travis Pentz.
  • In addition to the International Emergency Packet, there are other tasks that must be completed by all students requesting credit or funding for their time abroad. Please see the checklist on the Trainee International Travel Resources for requirements.
• Additional forms required for international clerkships:
  • Request for Credit: Extramural Course or Clerkship Approval Form (Use the international form for the corresponding UCSF department; follow submission instructions on form.)
  • Global Health Elective Course Objectives Form (This same form is part of the Inquiry Funding Office application for grant funding. If you do not apply for funding, fill this form out with your department mentor before travel, and the mentor will use this form when submitting your evaluation for credit.)
• Additional forms required for international research:
  • Request for Credit: 150 Research Elective Credit (Follow submission instructions on the form.)

Administrative Forms

• 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

Registrar Forms

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