Students and Student Organizations Participating in
Extracurricular Clinical Activities

MSUCOM students are encouraged to participate in extracurricular clinical activities. In order to participate in these activities MSUCOM students and student organizations are required to have on file in the Office of Student Services, a completed and approved Student and Student Organization Extracurricular Clinical Activity Approval Form. This form must be submitted to the Office of Student Services at least one week in advance of the extracurricular clinical activity.

The form will be reviewed by either the Associate Dean for Student Services or the Assistant to the Associate Dean for Student Services. The student or student organization will be notified of the decision of the Associate Dean for Student Services or the Assistant to the Associate Dean for Student Services in a timely fashion. If the request is denied, a reason for the denial will be transmitted back to the student or student organization on the submitted form. All extracurricular clinical activities must be supervised by a physician(s) and his/her name(s) and signature(s) must appear on the form when it is submitted. Failure to complete the form in its entirety will result in a denial of student or student organization participation in an extracurricular clinical activity.

Forms are available in the Office of Student Services (C-103 and C-110 East Fee Hall) or may be downloaded by clicking on the links below.

Extracurricular Clinical Activities Approval Form

Microsoft Word (.doc)

Adobe Acrobat (.pdf)