Forms

Away Rotation Application

• House Staff must reach out to Program Director and Program Coordinator regarding away rotation logistics, such as funding and application submission.
• Then Program Coordinator works closely with the house staff to submit the away rotation request to GME.
• See Policies & Procedures: Away Elections/Rotations.

• Must be completed and returned to the GME office to receive Final Paycheck and certificate. 
• Final Paycheck is NOT a direct deposit.
• See Policies & Procedures: Completion of Training.

• Types of LOAs: Bereavement, Family Leave, Jury Duty, Medical Leave (Non Pregnancy, Pregnancy), Paternity, Personal Leave.
• Prior to working with Matrix, please submit completed GME LOA Form with your Program Director’s signature to Ann Dohn, GME Director, DIO for approval.
• See Policies & Procedures: Leave of Absence.

• The GME Office will NOT reimburse you if you pay out of pocket. You must submit the completed LSTC-GME Payment Authorization form for Approval/Sponsorship for payment 3 weeks prior to enrolling in the class.
• Additionally, the GME Office does not fund or reimburse registration for lapsed recertification’s OR for graduating house staff.
• See Policies & Procedures: Mandatory Procedures.

• This form is a security clearance for CA Medical License processing.
• To learn more, please visit the Medical Board of California under Questions Regarding Fingerprints.

• Please read the form and reimbursement page carefully for various deadlines.
• Reimbursements are made by payroll and directly deposited to house staff’s account. 
• House staff can confirm receipt of a payment made by payroll by checking their paystub on Lawson eConnect.
• See Policies & Proecdures: Reimbursements.

• Lottery packet/guidelines are sent to new/incoming house staff along with their contracts in the Spring.
• To learn more, read more about Welch Road Apartments here.