Clinical Rotation Request

STUDENT INFORMATION

Student Name & Address:

   
   
 
 

In order to schedule clinical rotations, the form needs to be submitted at least six (06) weeks prior to the requested start date. Students are required to have this document completed and submitted to the Clinical Rotation Coordinator of Greenheart Medical University, School of Medicine for clearance from the Bursar & Registrar’s Departments.

Rotation (s) Requested No. of Weeks Start Date Core / Elective

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I hereby agree to the terms & conditions per GMU policy.Date: 11/18/2017




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