Schedule Change Request Form

MS2s are scheduled for 12 consecutive months of core clerkships; modifications to this schedule (such as a gap in enrollment) will not be considered except in unforeseen, extenuating circumstances. The 4-week elective block and/or two, 2-week intersession periods (following Pediatrics and OB GYN) provide additional flexibility for students.

For MS3s, Schedule Petition Committee is unable to entertain petitions for core schedule changes (Family Medicine, Neurology, Pediatrics, Psychiatry, OBGYN, Medicine, Surgery). The Committee will only be reviewing petitions for Group A Selectives, Sub-I, and Emergency Medicine rotation changes.
1.Student Name(Required.)
2.Student ID(Required.)
3.Class Level(Required.)
4.Are You A Dual Degree/MSRT Student?(Required.)
5.What Is Your Specialty Interest?
(i.e. Medicine, Pediatrics, Orthopedics, Dermatology)(Required.)
6.Have You Previously Submitted a Petition Request for the Committee to Review?
7.Please Select a Category For Making This Request(Required.)
8.Please Provide Additional Justification For Making This Request(Required.)
9.Please Specify What Changes You Are Trying to Make to Your Schedule
(i.e. I have a general medicine sub-internship in February of 2019 and I would like a family medicine sub-internship in July of 2018)
Please be sure to include time-frames (quarter, terms, months, blocks) and  any time-frame restrictions you may have.
(Required.)
Current Progress,
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