VSLO Add/Drop Form

VSLO Add/Drop Form

By checking this box I understand that:*

*THIS FORM MUST BE SUBMITTED AT LEAST 90 DAYS IN ADVANCE OF THE START OF THE ROTATION.

*OMSA MUST SECURE AN AFFILIATION AGREEMENT BEFORE A VSLO COURSE CAN BE ADDED TO MY SCHEDULE.

*THIS ROTATION IS NOT APPROVED UNTIL I RECEIVE A CONFIRMATION EMAIL VERIFYING APPROVAL.

Submission of this request is not a guarantee of approval, and I should check in w/ OMSA before making any non-refundable travel arrangements. If I do make lodging arrangements (rentals) *before* the affiliation agreement has been approved – it is at my own financial risk.

If an affiliation agreement is not secured before my rotation begins, I will not be able to earn credit for the course and will not be covered by UNM's malpractice insurance.

Note: OMSA has seen some agreements take more than 90 days depending on negotiations and approvals between the legal teams of the host and home institution. While it is never our intent to deny a credit request, we cannot approve any requests without a fully executed agreement.

UNM ID*

First Name*

Last Name*

Salud Email*

Today's Date*

Class of*

Are you adding or dropping a VSLO course?*

You must be already be approved in VSLO to add this course to your schedule. To drop, you must have previously submitted an add form to OMSA.

Select

I have already been accepted by host institution in VSLO.*

If you have not been accepted you must wait to submit this form.

Course Name*

Department/Specialty*

Course start date*

Course must be 4 weeks to count as a 4th year elective.

Course end date*

Name of Institution*

Name of course contact*

Name of person OMSA should contact for your grade.

Course contact email*

Course contact listed in VSLO. OMSA will use this contact to obtain your grade.

City & State*

Physical Address*

Additional informational (optional)

Send me a copy of my responses

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