University of California, Riverside

UCR School of Medicine Student Affairs



Forms, Policies and Procedures


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Forms, Policies and Procedures for Medical School Students

This page contains links to the most common forms used by students at the UC Riverside School of Medicine.

The forms are all editable PDFs which you can download to your computer, fill out, save, then print or send electronically. Please note that the editable function may not work within your browser. To save the files, right-click on the link and select the "save file" option.

If you need a form that is not listed on this page, please contact the Office of Student Affairs between the hours of 8 a.m. to 5 p.m., Monday through Friday.

Student Handbook

UCR School of Medicine Student Handbook

The handbook is the reference for all students in the Medical Education Program (MEP) at the UCR School of Medicine. You can view the handbook online or download it as a PDF.

Absence/Leave Forms

Approved Absence Request

Use this form to request time off for doctor's appointments, conference attendance, or other personal events.

Medical Leave of Absence (MLOA) Request

Use this form to request extended time off due to health and/or medical needs.

Return from Medical Leave of Absence (MLOA) Request

Use this form to request permission to return after a medical leave of absence.

Leave of Absence (LOA) Request

Use this form to request extended time off for reasons other than health/medical needs.

Return from Leave of Absence (LOA) Request

Use this form to request permission to return after a non-medical leave of absence.

Leave of Absence Extension Request (LOA)

Use this form to request additional time off during an approved leave of absence.


Forms for Current Students

Document Request Form - Current Students

Use this form to request documents such as transcripts, enrollment verification and letters of good standing.

Letter of Recommendation Request Form

Use this form to request a Dean's Letter of Recommendation for fellowships, scholarships or other educational opportunities.

Name Change or Correction Form

Use this form to request a change of name on all SOM student records in connection with a legal name change.

Health Clearance Update for Returning Students Form

These are the vaccinations and immunizations required annually for all students.

Forms for Incoming Students

HIPAA Release Form

This confidentiality statement details that non-workforce members abide by the regulations of the federal Health Insurance Portability and Accountability Act (“HIPAA”), the California Confidentiality of Medical Information Act and other federal and state laws and regulations.

Vaccination and Immunization Requirements for Incoming Students

These are the vaccinations and immunization required of all incoming medical students prior to the start of Orientation Week.

Medical Student Insurance Information Form

This form is to be used to detail the insurance information for students of the UCR School of Medicine.

Other Forms

Provision of Medical Treatment to UCR SOM Students by UCR SOM Faculty

Use this form when being treated by a UCR clinical faculty member to clarify if the health issue is of a sensitive or non-sensitive nature.

Other Resources

Exposure to Blood Brochure - What Healthcare Personnel Need to Know

This brochure on occupational exposures to blood is produced by the Centers for Disease Control and Prevention and the Department of Health and Human Services. By clicking the link, you will be taken to the CDC website to view the PDF.

The policy on blood and body fluid exposure appears in the Student Handbook.

More Information 

General Campus Information

University of California, Riverside
900 University Ave.
Riverside, CA 92521
Tel: (951) 827-1012

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