8/3/2019 Checklist for International Student 10-15-2010

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CHECKLIST FOR NON-UIC INTERNATIONAL MEDICAL STUDENTS

APPLYING FOR ELECTIVES AND SUB-INTERNSHIPS

AT THE UNIVERSITY OF ILLINOIS COLLEGE OF MEDICINE

UIC APPLICATION FOR CLINICAL EXPERIENCE

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.

ELECTIVE FEE NOT REQUIRED FOR LCME-APPROVEDOR DOMESTIC MEDICALSCHOOLS .

International Students: $300 USD processing fee per elective payable to UIC in the formof a money order, travelers check or cashiers check. If paid by check (check must be drawnfrom a US bank)

Fee waived (IFMSA only)

LETTER OF GOOD STANDING

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)

PREREQUISITE CORE CLERKSHIPS Official Transcript (or letter from the Dean of Students) verifying each core clerkshipand total

weeks/hours completed in each: ___ Medicine ___ Obstetrics/Gynecology ___ Pediatrics ___ Psychiatry ___ Surgery ___ Family Medicine

UIC IMMUNIZATION COMPLIANCE FORM

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.

HEALTH INSURANCE

Specific coverage/benefits provided (i.e. Student's Name, effective dates, group or policynumber, Coverage Limits, Hospitalization, Emergency Care) and, for international

students, Evacuation and Repatriation) certified by:

A copy of personal health insurance card and detailed information on the coverage of benefitsprovided (i.e. coverage limits, hospitalization, emergency care). A booklet or pamphlet fromthe company will suffice -or

Language in a letter from Dean of Students certifying coverage of health insurance while atthe University of Illinois, College of Medicine.

MALPRACTICE INSURANCE

A copy of liability insurance or a letter from the Dean of visitors medical school indicatinglimits of liability not less than $1 million per occurrence and $1 million per policy period.

U.S. CITIZENSHIP / RESIDENCY / VISA STATUS

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.

EVALUATION FORMS

Visitors medical school should provide blank evaluation form with instructions for return bymail to appropriate entity-or

Preceptor will use UIC form. When completed it will be returned by mail to appropriate entity.

HIPAA CERTIFICATION

http://www.hipaatraining.com HIPAA certification date (documentation)

11.TOEFL

http://www.hipaatraining.com/http://www.hipaatraining.com/

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

***HOUSING & ADDL EXPENSE INFORMATIONVisiting 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

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