Get the free Medical student departure form (PDF) - UPMC.com

MEDICAL STUDENT DEPARTING FORM This form is to be completed by students upon completion of a rotation and submitted to Annmarie Klutz in Medical Education. Students should report by 3 PM on the final

How to fill out medical student departure form

How to fill out medical student departure form

1. Start by obtaining a copy of the medical student departure form from your institution's medical education office.
2. Carefully read all the instructions provided on the form to understand the requirements and the information you need to provide.
3. Fill in your personal details accurately, including your full name, student ID number, contact information, and the date of departure.
4. Specify the reason for your departure and the expected date of return, if applicable.
5. Provide details about your current program or rotation, including the name of the hospital or clinic, the department, and the supervising physician.
6. Indicate any pending obligations or incomplete tasks that need to be addressed before your departure.
7. If required, attach any supporting documents such as medical certificates or official letters.
8. Review the form for completeness and accuracy before submitting it to the appropriate authority or office.
9. Follow any additional steps or requirements as mentioned by your institution in order to finalize the departure process.
10. Keep a copy of the filled-out form for your records.

Who needs medical student departure form?

1. Medical students who are planning to take a temporary leave or end their educational program at a particular institution.

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What is medical student departure form?

The medical student departure form is a document that is used to officially notify the school or institution of a student's decision to leave or withdraw from their medical program.

Who is required to file medical student departure form?

All medical students who are planning to leave or withdraw from their program are required to file the medical student departure form.

How to fill out medical student departure form?

To fill out the medical student departure form, students must provide their personal information, program details, reason for departure, and any other required information requested by the school.

What is the purpose of medical student departure form?

The purpose of the medical student departure form is to inform the school or institution about a student's decision to leave the medical program, and to officially document their departure.

What information must be reported on medical student departure form?

The medical student departure form must include the student's personal information, program details, reason for departure, and any other information required by the school.