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Medical Elective Authorization Form

The document is a Medical Elective Authorisation Form for students in the Faculty of Medicine at The University of Queensland. It includes sections for student and home institution details, authorisation of the student's good standing, and approval for completing a medical elective. The form also requires verification from an officer and includes a university stamp.

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Lily Chan
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15 views1 page

Medical Elective Authorization Form

The document is a Medical Elective Authorisation Form for students in the Faculty of Medicine at The University of Queensland. It includes sections for student and home institution details, authorisation of the student's good standing, and approval for completing a medical elective. The form also requires verification from an officer and includes a university stamp.

Uploaded by

Lily Chan
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Medical Elective Authorisation Form Faculty of Medicine

Student Details Home Institution Details


Name Institution Name

Student Number Name of Dean (or Designate)

Program of Study Position Title

Expected Graduation Date: Month Year Telephone

Mobile Phone Number Email

Email Postal Address

Postal Address

Suburb Postcode Suburb Postcode:


Country Country

Authorisation

This is to certify that the above student is a medical student at and is of good
standing. This student is currently in their year of study. Upon undertaking this elective this student will be
in their year of study.

This student is approved to complete a medical elective through The University of Queensland from

Start Date / / Finish Date / /

The student has successfully completed the minimum of 1 semester of clinical immersion as per the policy
of The University of Queensland. This can be evidenced from the Academic Transcript by completion of the
following course/s:

Course Code: Course Name:

Course Code: Course Name:

Course Code: Course Name:

Signature of Verifying Officer

University Stamp
Position

Date

[Link]
CRICOS Provider Number 00025B

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