Get the free CLINICAL CLERKSHIP CHANGE FORM - Icahn School of Medicine

One Gustav L. Levy Place Vandenberg Building Room 13-30 Box 1257 New York, NY 10029-6574 Phone: (212) 241-6691 Facsimile: (212) 369-6013 Email: Registrar SSM.edu CLINICAL CLERKSHIP CHANGE FORM S STUDENT

How to fill out clinical clerkship change form

How to fill out clinical clerkship change form:

1. Obtain the clinical clerkship change form from your medical school or the appropriate department.
2. Fill in your personal information, such as your name, student ID number, and contact information, in the designated fields.
3. Indicate the reason for the requested change in your clinical clerkship. This could be due to scheduling conflicts, personal reasons, or academic considerations.
4. Specify the current clinical clerkship you are enrolled in and provide details about the new preferred clerkship you wish to switch to. Include the clerkship name, dates, and location if applicable.
5. If there are any specific requirements or approvals needed for the switch, make sure to provide the necessary information or documentation.
6. Sign and date the form to indicate your agreement and understanding of the change request.
7. Submit the completed form to the appropriate person or department as per the instructions provided.

Who needs clinical clerkship change form:

1. Medical students who need to change their assigned clinical clerkship for various reasons.
2. Students who have encountered scheduling conflicts or have personal reasons that make it necessary to switch clerkships.
3. Those who wish to make academic adjustments or pursue specific areas of interest by changing their clinical clerkship assignment.

For pdfFiller’s FAQs

What is clinical clerkship change form?

The clinical clerkship change form is a document used to request changes to a medical student's clinical clerkship schedule.

Who is required to file clinical clerkship change form?

Medical students who need to make changes to their clinical clerkship schedule are required to file the clinical clerkship change form.

How to fill out clinical clerkship change form?

To fill out the clinical clerkship change form, students must provide their personal information, the details of the requested changes, and any supporting documentation.

What is the purpose of clinical clerkship change form?

The purpose of the clinical clerkship change form is to allow medical students to request changes to their clinical clerkship schedule in cases of emergencies or unforeseen circumstances.

What information must be reported on clinical clerkship change form?

The clinical clerkship change form must include the student's name, contact information, current schedule, requested changes, reason for the changes, and any supporting documentation.

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