Forms

Academic Forms

• Absence Request Forms
  • Absence Request Form (for all phases)
• LOA / Alternative Path Request
  • FMK Phase LOA / Alternative Path Request Form
  • FCC Phase LOA / Alternative Path Request Form
  • Immersion Phase LOA / Alternative Path Request Form
• Late Add/Drop Form
• One Hundred Oaks Parking Request Form
  Questions? Email Daravanh Weeks
• Primary Care Forms
  • Primary Care Setting Request: Form 5100
  • Petition for Away Primary Care Credit (at another institution): Form 5150
• Research Forms
  • Research Immersion: Participation Preference Survey
  • Research Immersion Extension Request Form
  • Research Project Details Form
• Special Study Forms
  (Note: You must open and edit these documents in Adobe Acrobat and save as PDFs. Please follow the directions for each individual form. These forms must be turned in no less than 28 days in advance.)
  • Form 6100: Petition for Clinical Special Study (at VUSM)
  • Form 6150: Petition for Research Special Study (at VUSM)
  • Form 6200: Petition for Non-Clinical Special Study (with Vanderbilt-affiliated course director)
  • Form 7100: Petition for Clinical Rotation (Away) – must be completed 28 days prior to the start of your rotation or you will not receive credit toward graduation
    • If you are requesting a 3-week away rotation, use the form here
  • Form 7101: Petition for Special Study (Away, 2 weeks at 2 locations, must be in same specialty) – must be completed 28 days prior to the start of your rotation in order to be registered

Student Life Forms

• Medical Student Affairs Conference Funding
• Outside Funding Request
• Outside Speaker Request
• Oracle
• Concur
• Student Reimbursement Information
  • MSA Student Spending Form
  • Medical Student Research Conference Reimbursement
  • MSTP Reimbursement
  • USMLE Step 1 OR Step 2 Practice Test Reimbursement
• Event Supply & Beverage Request (This form is closed at this time)
• Tax Exempt Form
• VUSM Undergrad Mentorship Program
• White Coat Order Form
• Campus EMS