CHECKLIST FOR NON-UIC INTERNATIONAL MEDICAL STUDENTS APPLYING FOR ELECTIVES AND SUB-INTERNSHIPS AT THE UNIVERSITY OF ILLINOIS COLLEGE

OF MEDICINE
U I C A P P L I C AT I O N F O R C L I N I C A L E X P E R I E N C E

Part I completed by the student; and Part II completed, signed by visitor's Dean of Students; and The school seal must appear on each application. (Original document with embossing or distinctive colored stamp is required) ; and Photograph must be affixed to each application.
REQUIRED FOR

ELECTIVE FEE NOT

LCM E- A PPROV ED

OR DOMESTIC MEDICAL SCHOOLS.

International Students: $300 USD processing fee per elective payable to UIC in the form of a money order, travelers check or cashiers check. If paid by check (check must be drawn from a US bank) Fee waived (IFMSA only) Letter of good academic standing signed by visitor's Dean of Students; and School seal or distinctive-colored stamp must appear on this letter. (Original document required) Official Transcript (or letter from the Dean of Students) verifying each core clerkship and total weeks/hours completed in each: ___ Medicine ___ Obstetrics/Gynecology ___ Pediatrics ___ Psychiatry ___ Surgery ___ Family Medicine Form completed, signed and verified by an MD, DO, RN, CANP or PAC; and Copies of immunization records and lab slips supporting the UIC Immunization Compliance Form. Specific coverage/benefits provided (i.e. Student's Name, effective dates, group or policy number, Coverage Limits, Hospitalization, Emergency Care) and, for international students, Evacuation and Repatriation) certified by:

L E T T E R O F G O O D S TA N D I N G

PREREQUISITE CORE CLERKSHIPS

U I C I M M U N I Z AT I O N C O M P L I A N C E F O R M

H E A LT H I N S U R A N C E

A copy of personal health insurance card and detailed information on the coverage of benefits provided (i.e. coverage limits, hospitalization, emergency care). A booklet or pamphlet from the company will suffice -or Language in a letter from Dean of Students certifying coverage of health insurance while at the University of Illinois, College of Medicine. A copy of liability insurance or a letter from the Dean of visitors medical school indicating limits of liability not less than $1 million per occurrence and $1 million per policy period. Proof of U.S. Citizenship (birth certificate and social security card or U.S. passport) or International Passport (students can come to the US on a B1 visa), whichever applies. Visitors medical school should provide blank evaluation form with instructions for return by mail to appropriate entity-or Preceptor will use UIC form. When completed it will be returned by mail to appropriate entity. http://www.hipaatraining.com HIPAA certification date (documentation)

MALPRACTICE INSURANCE

U . S . C I T I Z E N S H I P / R E S I D E N C Y / V I S A S TAT U S

E VA LUAT I O N F O R M S

H I PA A C E RT I F I C AT I O N

11.TOEFL

Click here for the TOEFL certification at ets.org Courses taught in English need to be verified with a letter from the Dean

*** H O U SI N G & A D D L E X P E N S E I N F O R M AT I O N Visiting students responsible for supplying short lab coat, nametag, meals, and living arrangements. They pay no tuition or additional fees. Neither credit cards nor currency will be accepted.
Revised 11/13/11 MMH