Skip redundant pieces
School of Medicine

REQUEST FOR ENROLLMENT IN A SUMMER ELECTIVE

(Class of 2010 only)

It is your responsibility to make sure that you complete this form on or before May 7, 2007, so that enrollment and/or financial aid are completed in a timely manner.  The completed form should be submitted electronically by this deadline in order to receive academic elective credit.

Once you have received permission/acceptance to enroll, please complete the form below. Review the listing of course numbers and make sure you enroll in the correct course.

The completed form(s) must contain a written description of the educational experience, the reason for proposing such a program and written indication of faculty or supervisory personnel of their willingness to evaluate the student's performance. Elective credit will be accrued at the rate of two credits for four weeks or four credits for eight weeks. The maximum number of elective credits hours you can obtain over the summer between your first and second year of medical school is four. Please note that an ADD form must be submitted for each course in which you are requesting to be enrolled.

Course listing

  • IDSP 800 – Medical students will be enrolled in this course if they are seeking elective credit for experiences completed during the basic science years.  These courses include, but are not limited to,
    • a research training experience,
    • clinical education experience
    • an international outreach/medical missions,
    • Philmont Scout Ranch (Course Director, Dr. Ken Goertz),
    • International Research (Course Director, Dr. Joe Bast)
  • FAPR 905 - Rural Family Medicine - Practice and Research - Course Director, Dr. Allen Greiner
  • HPMD 909 - Clendening Research Fellowship - Course Director, Dr. Martha Montello
  • MED 925 - Community Health Project - Course Director, Dr. Cheryl Gibson
First Name
Last Name
KUID
Email
Course Number   Example: IDSP 800
Credit Hours   2 OR 4
Beginning Date  Format: dd/mm/yy
Ending Date   Format: dd/mm/yy 
Location
KUMC, VAMC, Other (Hospital, City, State)
Full name of supervisor/evaluator
Supervisor/evaluator's telephone number
Fax # of supervisor/evaluator (optional)
Email address supervisor/evaluator