Scholarship Applications and Instructions:  Richardson and Tan

UIC Medical Center  Network Access  (Powerchart)

Confidentiality Agreement

 

Student Request Form (SRF)

request letters (good standing, jury duty, insurance, USMLE certification, recommendation), immunization record updates, files/copies, alumni dean's letters, etc.

Mandatory Immunization Documentation Form

 This is the only form accepted by the UIC College of Medicine Admissions Office.  It collects and presents evidence of compliance with requirements of the College and its affiliate clinical sites.  Attach original Lab slips, reports and certificates to this form; keep copies; submit the original to Student Affairs.  Note:  The form is valid when signed by an MD, RN or DO.

 

TB Surveillance Questionnaire

Completion of this form is required of students who have either "a positive QuantiFERON TB gold blood test, a positive PPD, or an allerby to a component of the PPD solution used for skin testing."

CampusCare Health Forms

Information on the CampusCare program is available at : http://www.uic.edu/hsc/campuscare/chicago.

 

Change of Address, phone or pager number via UIC Student Access System -- UI-Integrate Student Self Service.
This replaces the function of OSA's Student Information Form (
SIF)

 

Professionalism Forms