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CLINICAL
COURSE CHANGE FORM
Instructions:
A total of up to four (4) elective course schedule changes are permitted.
(A drop and add within the same module constitutes one (1) schedule change.)
A Clinical Course Change Form must be completely filled in by the student,
before submitting to the Department. Requests for course changes must
be received six (6) weeks prior to the beginning of the module starting
date.
|
|
Date:
________________ |
| Student
Name: _______________________________ |
Person
#: _____________ |
| Department:
___________________________________________________________________ |
|
|
| Mod |
Course
Number
|
Course
Title |
Instructor |
|
|
_ |
_ |
|
|
|
|
| ______ |
______ |
______ |
______ |
____________________________________ |
______________________ |
| _____
ADD |
_____
DROP |
|
|
Reason
for Change:
______________________________________________________
______________________________________________________ |
|
|
|
|
| ___________________________________________________________ |
Date:
____________________
|
| Department
Coordinator Signature |
|
Departmental Course Monitors should
provide students with a signed copy of the form and forward the original
form to the Office of Medical Education for processing. |
