Absence Request
An Absence Request is required for all absences from UMDNJ-SOM clinical rotations, including conference attendance, taking COMLEX, going for interviews and utilizing your personal day. You must obtain the Clerkship Director's signature a minimum of 7 days in advance of the requested absence date. Absences during electives must be arranged directly with the elective site, and do not require an Absence Request.

Change in Rotation
The Change in Rotation form is required for all changes to the Year III or Year IV schedule, including change of dates, sites, or clerkship. This form should be turned in to the Clinical Education Coordinator at least 30 days prior to the clerkship start date. Schedule changes will not be made until this form has been received.

Clinical Evaluation
The Clinical Evaluation Form is the form used to grade students on their clinical rotations. Students are given copies of this form each year. If you do not have a copy of your form handy, you may print a copy from here. Each clerkship has specific rules regarding completion of the evaluation form(s), so check with your Clerkship Director if you have any questions.

Clinical Skills Checklist

The checklist is used during third and fourth year clinical rotations to verify that the student has achieved competency in each of the listed skills. Each student should hand in the completed checklist to the Clinical Education Coordinator once competency has been archived in all the skills.

Elective Application
The Elective application is required for all Elective, Family Practice Elective and Medicine Elective rotations, whether in- or out-of-system, a minimum of 30 days in advance of the start date. You should complete all of Part I, including complete contact information for the site. Then turn in the application, along with any other documents the site may require, to the Clinical Education Coordinator.

Independent Study Application
An Independent Study may be completed during vacation time or night/weekend hours while on a regularly scheduled rotation.

This form should also be used by first and second year students for medicine-related activities outside of class or summer programs. Several signatures are required.

Out-of-System Required Rotation
This form should be used (and only used) for Anesthesia, Surgical ICU or Trauma as the Year IV Surgical Specialty or for Year III Radiology done out-of-system. This form is due 30 days prior to the start of the rotation and should be turned in to the Clinical Education Coordinator.

Rotation Evaluation Form
The Rotation Evaluation process is an online process. To complete your evaluations log on to http://www.umdnj.edu/webctweb

Your WebCT ID is equal to the beginning of your umdnj email address, (i.e. if the umdnj email address is smitha@umdnj.edu, the WebCT ID is smitha). When you log in your password is the last four digits of your social security number. Select "SOM 2006-2007 Clerkship Evaluations" for your year. On the next screen, click on the link "Go to Evaluations." Then click on the link for the rotation you have completed (for example, "Internal Medicine"). Please note that when you complete any of the "elective" evaluations, you should indicate specifics about the specialty (e.g. Dermatology) and the site (e.g. Thomas Jefferson) in the text box. If you have trouble logging in or experience technical difficulties, contact the UMDNJ Technology Service Center at 973-972-9832 or use the help desk link. From an on-campus phone, dial 2-9832.

Request to Make Up Clinical Weeks (Leave of Absence Application)

A leave of absence application is required for medical, academic, or personal absences from UMDNJ-SOM clinical rotations over 5 days. This is reviewed by the Clinical Education Coordinator and discussed with the Assistant Dean of Student Affairs before a leave of absence is approved. All missed weeks are required to be made up before you will be eligible to graduate.

Still have questions? Contact:

Fatmata Kabia, M.P.A.
Clinical Education Coordinator
Office of Academic Affairs
One Medical Center Drive, Suite 210
Stratford, NJ 08084-1501
Phone: (856) 566-6726
Fax: (856) 566-6341
Email: kabiafy@umdnj.edu