2020 International Visiting Student

    Date of Birth:
    Present Address:

    Address of Home Medical School:

    ELECTIVE COURSE(S) REQUESTED: Please list in order of preference with course number – e.g.: PEDS 407 Course descriptions can be found here. International visiting students are not eligible to participate in courses label ACSM, AHEC, MESE and SURS. Additionally, visiting students are not eligible to participate in Internal Medicine (MEDI), Obstetrics and Gynecology (OBGN), or Family Medicine (FMME) courses located in Charlotte, NC or Wilmington, NC. These are electives which are only available to UNC students. Please do not list these on your application.
    ELECTIVE BLOCK(S) PREFERRED:Please list in order of preference. Refer to the UNC SOM elective calendar here. Study visits must conform to beginning and end dates and all electives are 4 weeks long.
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    STATEMENT OF VISITING MEDICAL STUDENT –Acceptance of the condition of your visit to UNC CH. “I am aware that acceptance as a Visiting Student carries no implication concerning formal admission to or matriculation at the UNC-CH School of Medicine. I certify that I am a final year medical student in good standing at my home institution and I have completed a criminal background check for my home institution and/or have no criminal violations. I understand that I have to pay a $2500 administrative fee per elective ($2500 per four week time block). Evaluation of my performance while studying at the UNC-CH School of Medicine will be based on the same criteria as those used to judge matriculated students at UNC-CH. I am aware that I must purchase personal health insurance from a US carrier while I am participating in an elective at the UNC-CH School of Medicine; that I must take two short courses at UNC-CH on Tuberculosis and Blood borne Pathogens; and that proof of full compliance with UNC Hospitals’ immunization requirements is a prerequisite for placement in an elective at UNC-CH. I understand that the course MEDI 408 Hematology/ Oncology Consults will not provide Letters of Recommendation for visiting students and students are not to request LORs from MEDI 408 faculty. Instead, after the elective, the Office of Student Affairs will generate a letter based off of the faculty evaluation grade and comments on the student’s behalf.”
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