REQUEST FOR ENROLLMENT IN A SPECIAL PROGRAM

(IDSP 800, IDSP 801, IDSP 804, IDSP 805, IDSP 900)

It is your responsibility to make sure that you complete this form as soon as possible, so that enrollment and/or financial aid are completed in a timely manner.  The completed form should be returned to Laura Zeiger, 3040 Murphy for KC students, or Melanie Runge, Academic and Student Affairs for Wichita students.

REQUEST FOR ENROLLMENT

(Please check the appropriate box and complete the attached form) 

ٱIDSP 800 – Medical students will be enrolled in this course if they are seeking elective credit for experiences completed during the basic science years at institutions other than KUMC or at KUMC but in departments that do not have an elective course number.  These courses include, but are not limited to, a research training experience or a clinical training experience, during the summer session between the first and second years of medical school.    Elective credit will be accrued at the rate of four credits for eight weeks or two credits for four weeks.

ٱIDSP 801 - Medical students will be enrolled in this course when the Academic Committee of the School of Medicine recommends a remedial program for a student that involves academic preparation for   which the student cannot enroll for credit or a grade. student who has failed a course.  Remediation may take place at KUMC or at another institution approved by the course director.  Students will be enrolled for the same number of credit hours as the course they failed.  Evaluation of the student's performance must be submitted bymust be obtained from the remedial program director upon completion of the remedial program either in a letter from the instructor or by having a transcript of the work sent to the Associate Dean for Student Affairs.  Enrollment in IDSP 801 at KUMC during the fall or spring semesters will result in one additional semester of tuition assessed during the semester of this course. Enrollment in IDSP 801 at KUMC during the summer will result in a per credit hour tuition rate during the summer semester.  Students who do coursework at other schools do not pay tuition and fees at KUMC.

ٱIDSP 804 - Medical students will be enrolled in this course when the Associate Dean for Student Affairs, the Associate Dean for Academic and Student Affairs or the Academic Committee approves a program for a student that may include a prolonged absence from the School of Medicine.  The student’s experience may include, but is not limited to, a fellowship, research or Master’s program.  The student will not receive credit, a grade or evaluation of their performance. A letter of acceptance from your program of study must be attached to this completed form.  Students must adhere to the School of Medicine policy stating that graduation requirements must be completed within six years of the date of matriculation into medical school.  The clock does not stop while a student is enrolled in IDSP 804.

ٱIDSP 805 - Medical students will be enrolled in this course when the Associate Dean for Student Affairs, the Associate Dean for Academic and Student Affairs or the Academic Committee approves a program of study for a student who cannot enroll in the regular curriculum until a passing grade is achieved on Step 1 or Step 2 of the USMLE.  The student's experience may include, but is not limited to, a formal board preparation program. The student will not receive credit.  Students must adhere to the School of Medicine policy stating that graduation requirements must be completed within six years of the date of matriculation into medical school.  The clock does not stop while a student is enrolled in IDSP 805.

ٱIDSP 900 – Medical students will be enrolled in this course during their fourth year of medical school, if seeking elective credit towards the M.D. degree.  Enrollment is this course is for all elective experiences requested at institutions other than KUMC, or if no elective catalog number is available.  In addition to this form, the application must contain a written description of the type of educational experience sought and the reason for proposing such a program; written indication of faculty or supervisory personnel of their willingness to participate in the program and to evaluate the student's performance.  If the special program involves study in an area identifiable by department (Medicine, Surgery, Gynecology-Obstetrics, etc.) approval by the chairperson of the respective department or designate must be obtained. No more than eight weeks of special program credit is applicable towards the M.D. degree.  The application must be submitted at least two months before the expected starting date of the program. 

ENROLLMENT REQUEST 

NAME:_____________________________________________________ CLASS:_________

DATE: ____________________________  STUDENT I.D. #___________________

 I am seeking elective credit through enrollment in the following course: 

ٱIDSP 800           ٱIDSP 801           ٱIDSP 804           ٱIDSP 805           ٱIDSP 900

 Address and phone number where I may be reached during my enrollment.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

The course begins on _____________and ends on ______________Number of credit hours ___

Title of Course _______________________________________________________________

Location of course  _________________________________located in ____________________

                                         Name of hospital, school, office                                             City, State

An evaluation will be sent to the person listed below.  You must print their name, complete address, phone number.

 _________________________________________________(       )_______(       )_______

  Name                               Address                            City,State,Zip                    Phone                     Fax

I understand that the above information is true and accurate to the best of my ability.  I also understand that I am solely responsible for obtaining all of the information above and that if I DO NOT it could affect my grade in the rotation and receiving credit for the rotation as well.  A letter from the individual responsible for the program, outlining a description of the duties to be performed, inclusive dates of the course, and verification that an evaluation will be made at the conclusion of the course is attached.

 _____________________________   _________________________    _______________

                Signature of student                     Home phone/Cell Phone                            Date

Text Box: TO BE COMPLETED BY THE CHAIRMAN OR COURSE DIRECTOR OF THE DEPARTMENT AT KUMC

 

My approval is given for the above named medical student to participate in this course for credit.

       __________________________________   ____________________   ______________

        Signature Dept.Chair/Course Coordinator                    Department                            Date

Return Completed Form To 3040 MURPHY  (KC) or Office of Academic and Student Affairs (Wichita)

________________________________________________________________________________________________________________                                                                    

Signature of Academic and Student Affairs Dean                              Date

No fourth year medical student will be allowed to take a Special Program for credit at an institution not in the continental United States after April 1 of their fourth year.  This means that no grade will be recorded on the student’s permanent record for Special Programs taken during April, May, or thereafter, if a course is graded outside of the United States.  Fourth year students will be covered by malpractice until graduation, so long as they request enrollment by using this form.  Students who enroll in a course, and fail to appear for the course without formally withdrawing before the first day of the course, will be given an Unsatisfactory grade.