Return form to:
Registrar
One Gustave L. Levy Place Phone: (212) 241-6691
Annenberg Building Room 13-30 Facsimile: (212) 369-6013
Box 1257 E-mail:
New York, NY 10029-6574
Clearance to return from Scholarly Year is required. Students should complete this form with intended date of return or request for extension by March 1 of your Scholarly Year.
SUBMITTING THIS FORM AND RETURN CONDITIONS: Students on Scholarly Year must complete and submit this form to the Registrar by March 1 of your approved Scholarly Year. If the Registrar does not hear from you by this date, it will be assumed you no longer wish to continue your studies at Mount Sinai School of Medicine.
CLINCIAL REQUIREMENTS: All students returning to clinical rotations or electives must complete Clinical Requirements. A separate form will be sent once you have completed the Return from Scholarly Year form.
TUITION: Students on Scholarly Leave are granted a one year moratorium on tuition increases. For questions, please contact Enrollment Services at (212) 241-5245.
FINANCIAL AID: The priority deadline for applying for financial aid is May 1. Please contact Dale Fuller for questions about or to apply for Financial Aid: .
HEALTH INSURANCE: Students who dropped MSSM UHC insurance must re-sign with Mount Sinai Health Insurance within 30 days of their return date. For questions, contact Leonara Dasu at .
HOUSING: If not in housing, students must reapply for housing accommodations at the same time requesting readmission. Please contact Angela Moura at to file the appropriate paperwork.
LIST-SERVE: Students are not automatically placed on the list-serve until returned from Scholarly Year but may subscribe in advance by contacting the helpdesk: .
SCHOLARLY PRODUCT: A scholarly product is due 30 days before your date of return. Please submit to: .
The scholarly product may be:
· a 3-5 page final report on your project, including a cover page
· a manuscript you are preparing for publication
· a manuscript you have submitted for publication, including journal date and submission date
· a first author abstract you have submitted to a national meeting, with meeting name, dates and location
Failure to provide a scholarly product will result in you being put on administrative leave and your inability to return to clerkships.
Please note that final approval to return from a Scholarly Year cannot be granted until all required paperwork, including the Return from Scholarly Year form, the Clinical Requirements form and your Scholarly Product, have been completed and submitted.
Student Name (First, Middle Initial , Last)
Home Address / City / State / Zip
Life Number / Telephone Number
HOME CELL
Program
Scholarly Year Dates
Start Date: / Requested Return Date:
returning to year (for medical students only)
Year 1 Year 2 Year 3 Year 4
Mentor Name / City / State / Zip
Address / Telephone Number
HOME CELL
Title of Project
Or, if a degree was earned
Degree / Institution
Are you preparing a manuscript for publication? Y / N / Have you submitted a manuscript for publication? Y / N
Have you submitted a first author abstract for presentation at a national conference? Y / N
Required Signatures
Student Signature Date
Financial Services: Dale Fuller Date
Annenberg 5-05
Final Approval
Requested Date of Return Approved Requirements for return (if any):
Comments:
Dean/Program Director Date
Dr. Karen Zier, Associate Dean for Medical Student Research,
Director, Medical Student Research Office or
Dr. Christina Wyatt, Associate Director, Medical Student Research Office
Registrar: Nelson Pe Date
Return from Scholarly Year Form