Medical Students Clinical Rotation Request

First Name:

Last Name:

Phone Number:

Email:

Request type:

Clinical Rotation Site Request
Proof of Immunization and Certifications (after initial request has been approved)
Student Forms (after initial request has been approved)

Document #1 upload:

Document #2 upload:

Document #3 upload:

Document #4 upload:

Document #5 upload:

Security code:

Retype the numbers below:


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Documents to Upload

Initial Request

Clinical Rotation Site Request (PDF)

Once Approved

All students must provide proof of the following:
1. Current immunizations/immunity documentation:
  1. Measles, mumps, and rubella (MMR): 2 does of MMR – OR – positive lab titers showing immunity for measles, mumps and rubella
  2. Tuberculosis (TB): Negative TST test within the last 12 months
  3. Hepatitis B: completed 3 shot series, or positive antibody titer
  4. Influenza: Updated for current flu season (Oct 1 – March 31)
2. Malpractice or coverage letter for the school
3. Current Copy of BLS/ACLS certification
Students need to complete all forms

Join us in making a difference

Medical Students Clinical Rotation Request

Documents to Upload

Initial Request

Once Approved