This page contains links to the most common forms used by students at the UC Riverside School of Medicine.

The forms are all editable PDFs which you can download to your computer, fill out, save, then print or send electronically. Please note that the editable function may not work within your browser. To save the files, right-click on the link and select the "save file" option.

If you need a form that is not listed on this page, please contact the Office of Student Affairs between the hours of 8 a.m. to 5 p.m., Monday through Friday.

Academic Calendar

Download the 2023-2024 Academic Calendar

Download the 2024-2025 Academic Calendar

Leave of Absence Request Forms

Medical Leave of Absence (MLOA) Request
Use this form to request extended time off due to health and/or medical needs.

Leave of Absence (LOA) Request
Use this form to request extended time off for reasons other than health/medical needs.

Leave of Absence Extension Request (LOA)
Use this form to request additional time off during an approved leave of absence.

Forms for Current Students

Document Request Form - Current Students
Use this form to request documents such as transcripts, enrollment verification and letters of good standing.

Name Change or Correction Form
Use this form to request a change of name on all SOM student records in connection with a legal name change.

Annual Health Form for Continuing Students
These are the vaccinations and immunizations required annually for all students.

Student Handbook Acknowledgement Form

This form requires an annual signature to attest that you have been provided with the link to the electronic (online) Medical Student Handbook.

Technical Standards Acknowledgement Form

This form requires an annual signature to attest that you have been provided with the UCR School of Medicine technical standards (found in the Medical Student Handbook).

Forms for Incoming Students

HIPAA Release Authorization Form
This confidentiality statement details that non-workforce members abide by the regulations of the federal Health Insurance Portability and Accountability Act (“HIPAA”), the California Confidentiality of Medical Information Act and other federal and state laws and regulations.

Vaccination and Immunization Requirements for Incoming Students
These are the vaccinations and immunization required of all incoming medical students prior to the start of Orientation Week.

Other Forms

Provision of Medical Treatment to UCR SOM Students by UCR SOM Faculty
Use this form when being treated by a UCR clinical faculty member to clarify if the health issue is of a sensitive or non-sensitive nature.