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D G S M, Ucla Clinical Elective Drop/Add Form

This document is a clinical elective drop/add form for students at the David Geffen School of Medicine, UCLA. It provides instructions for students to add, drop, or change dates for electives by obtaining approval from the student coordinator. The form must be submitted to the coordinator at least 30 days before the start of the elective. Electives will not be automatically dropped if another is added for the same time period, so students must ensure their schedule reflects all changes. The completed form is then signed by the course coordinator and faxed to the Office of Student Affairs.

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Matt Dotson
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© Attribution Non-Commercial (BY-NC)
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26 views

D G S M, Ucla Clinical Elective Drop/Add Form

This document is a clinical elective drop/add form for students at the David Geffen School of Medicine, UCLA. It provides instructions for students to add, drop, or change dates for electives by obtaining approval from the student coordinator. The form must be submitted to the coordinator at least 30 days before the start of the elective. Electives will not be automatically dropped if another is added for the same time period, so students must ensure their schedule reflects all changes. The completed form is then signed by the course coordinator and faxed to the Office of Student Affairs.

Uploaded by

Matt Dotson
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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DAVID GEFFEN SCHOOL OF MEDICINE, UCLA CLINICAL ELECTIVE DROP/ADD FORM

Name __________________________________Class of _________Todays Date______________________

Student phone and pager numbers ________________________________

Drew/UCLA Students

All Elective Drop/Add Forms must be submitted to the student coordinator AT LEAST ONE MONTH PRIOR the start date of the elective.

STUDENT INSTRUCTIONS Use this form to ADD, DROP OR CHANGE dates for electives a. Contact student coordinator by telephone or email (contact information located in the Handbook of Courses) to check availability of dates for the elective you're interested in adding. b. Submit this form to student the coordinator to obtain approval signature (for both dropping and adding of courses). You may fax, mail, or hand deliver the form. Do not send the form without speaking to the student coordinator first. The form must be submitted to the student coordinator as soon as possible or at least 30 days prior to the start of the elective (for both dropping and adding) Failure to appear for a clerkship without submitting a signed Drop/Add Form 30 days prior to the start date may result in a FAIL Electives are not automatically dropped when Elective Drop/Add Forms are submitted for the same time period. It is your responsibility to make sure your schedule reflects all changes
Date Change From

Please check all that apply: ADD o

DROP

DATE CHANGE ONLY

o ____________
Location

_______________
Course # __________ Start Date to ____________ End Date

___________________________________________ __________
Course Name _____________ Starting Week # ______________ Total # of Weeks

STUDENT COORDINATOR INSTRUCTIONS Please fax the signed copy to Linda Cuesta, Office of Student Affairs, 12-159 CHS, Fax # (310) 794-9574 Please make a copy for your records and update your paper roster. Updates will be reflected on the ESS roster within two weeks of the SAO receiving this form If you have additional questions, please contact Linda Cuesta at (310) 206-0245

___________________
Course Chair Name

___________________________________________
Course Chair or Course Coordinator Approval Signature

_________
Date

___________________
Student Name
f:\shared\sao\forms\drop_add form co2011.doc Revised April 26, 2010

___________________________________________
Student Signature

_________
Date

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