Have the following eligibility/compliance information ready:
Application Form:
- Download/print the Dean's Statement Form and have it completed and signed by an authorized person from your school's Dean's Office, Student Affairs, or Registrar’s Office
- Have a copy of the Stanford clerkship contact's pre-approval, usually an email message saved as a PDF file. A pre-approval is required for each different clerkship being requested.
Acceptance Form & Medical Clearances (completed later if offered clerkship participation):
- Copy of your mask fit certification to show that you have successfully passed a Respiratory Mask Fit Test within the past 12 months (for Summer Quarter, no older than September 2022; for Autumn Quarter, no older than December 2022; for Winter Quarter, no older than May 2023; for Spring Quarter no older than June 2023)
- Enter health insurance policy details
- Provide proof of the following required immunizations and tests:
- MMR (Measles, Mumps, Rubella): 2 doses of live vaccines or laboratory evidence of immunity
- Varicella: 2 doses of live vaccines or laboratory evidence of immunity
- Hepatitis B: 3 doses of vaccine, or laboratory evidence of immunity from vaccination
- Tdap (Tetanus+Diptheria+Pertussis): Tdap booster (booster without Pertussis is not compliant), must be within past 10 years from the last day of the quarter
- Flu vaccine: Required seasonally October thru March (flu shot for 2022-2023 flu season)
- Tuberculin status:
- TB testing completed within 12 months prior to end of clerkship, with laboratory evidence of negative QuantiFERON Gold or T-spot blood test. PPD is not accepted.
- If history of a positive TB skin or blood test, a chest x-ray completed within 12 months of start of clerkship accompanied by positive TB test results.
- Completion of COVID-19 vaccination plus a booster
- If applicable, Supplemental Liability Insurance policy if home school's insurance is below $1M primary and $3M aggregate