Code of Conduct - New Requirement
All students must complete LA County's Code of Conduct exam. Please submit the completed exam and acknowledgment form along with the rest of the application packet. Code of Conduct -Compliance Awareness Training: Study Guide, Test
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| Program Eligibility:
Must be 4th year student at the time of clerkship (6th year for foreign student) |
North American Student Elective Application Part I form:
Part I requires school seal,
and an original signature (stamps not acceptable) |
| North American Student Elective Application Part II form: Part II requires original signature (stamps not acceptable) |
| UCLA Photo ID application form:
Must include a 2x2 photo attached (foreign students require two photos) |
| Transcript (unofficial transcript unacceptable):
Must indicate all prerequisites and successful completion of the course.
Letter from the course director will be accepted as verification of successful completion |
| Letter of Recommendation or Good Standing:
Must include supervised clinical experience |
UCLA Health Statement form:
Requires signature of a licensed physician
TB Immunization verification within the year of rotation - no exceptions |
| Health Insurance:
Requires proof of personal health insurance coverage during the clerkship.
Must include copy of medical insurance card |
Payment: Application Fees must be paid electronically by the student before they can mail the application to you. There should not be any checks enclosed with applications. Instead, they are to pay online and put their "Payment Confirmation Number" on the application. Before I send out any approvals, I will verify that they have paid the application fee. Fees are $100 for North American Students; $300 for International Students (except those coming from Hebrew University in Israel or Karolinska Institute in Sweden; due to exchange programs with these universities their students pay only $100)
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| HIPAA Certification:
UCLA HIPAA Certification |
