University of Pennsylvania

Perelman School of Medicine

Visiting Student Check List

(US or Canadian LCME or AOA approved schools)

Student Name______

Students applying for electives must be in their final year of medical school and indicate that the elective is to be taken for credit at the parent institution. All items on the checklist must be submitted at the time of application. Incomplete applications will not be processed until all documents on the check list are received.

A complete application will contain:

Application Form

___ Student Component

PLEASE NOTE:

In Step One of the online application, students who are interested in 1 month should select 4 credits. Students interested in 2 months should select 8 credits.

___ Home Institution Component

Malpractice/Liability Certificate of Insurance

___ Proof of Minimum Malpractice Coverage at the level of 2M/2M

___ Professional Liability Insurance Certificate

___ Commercial Liability Insurance Certificate

Health Forms/Insurance

___ Complete Immunization Record with appropriate signature (health care provider or student health office)

___ Proof of Health Insurance (Copy of insurance card)

Criminal Background Check

___ Is being provided by my school

___ I’ve started the process by contacting my local police station or the FBI or by contacting an online vendor. Documentation that I have done so is attached.

Child Abuse Clearance

For students pursuing rotations with extensive exposure to children, child abuse clearance is required. All applicants must submit at least proof that they have begun the process of obtaining clearance.

____ I have attached proof of child abuse clearance

____ I’ve started the process by contacting my state child abuse agency

TB Testing

TB testing must be performed within 12 months of your Penn elective dates

Date of last TB testing: ______

Date(s) I’m applying for: ______

____ I am up to date

____ I need to have another TB test done and will submit documentation

Evaluations

Upon the completion of your elective you will be evaluated via OASIS, our on-line evaluation system. The turnaround time for this process ranges from 6 to 8 weeks, with some evaluations coming in before and after suggested time frame. Once your performance evaluation is available, you can log into the system, using your OASIS user name and password, to view and print a copy for your school. If your school requires that an evaluation be sent to them directly, please have such requests sent to Justin Bittner ().

Supplemental Requirements

If you are applying for an Emergency Medicine, Otorhinolaryngology, Obstetrics and Gynecology, or Urology elective you will need to provide additional materials:

___Copy of CV

___Copy of Board Scores

___Copy of your medical school transcript

___Letter of Recommendation

All documents described in this check list should be sent in ONE packet by your home institution.