REQUIRED VA DOCUMENTS

The below documents are required for students rotating in Dermatology (140.03), Endocrinology (Med 140.77), Neurology 110 and Psychiatry 110 Clerkships.  The following forms are required of ALL medical students completing elective rotations at the VA:

* Faxed copies of completed forms are not acceptable.  Original signatures are mandatory.

 

 

VA Form 10-2850 Application for Health Professions Trainees 

• fill out, sign and date the above form
  
  

Declaration for Federal Employment

 

• fill-out, sign and date the above form

 

Statement of Commitment and Understanding for VA Trainees

 

• sign and date the above form

Department of Veterans Affairs Acceptance Letter/ WOC Letter

 

• WOC Letter will be emailed directly to the student
  
  

TMS Self Enrollment Training Instructions

Please view the attached PDF file for directions on how to access the combined training module.[PDF}

 

The following items are additional requirements of ALL students completing rotations at the VA:

 

• Copy of current PPD (TB status) – no more than 6 months old or no more than 1 year old form the end date of the student rotation.

• Fingerprinting – must be completed approximately 4 weeks prior to rotation.  Courtesy prints will be arranged for you at a designated location.

  
  

 

STUDENT INSTRUCTION SHEET (please print this instruction/check sheet and include with your paperwork)

Fingerprinting

Fingerprinting is required of ALL students rotating at the VA.  Be prepared to locate a local VA Hospital in your area.  The Fresno VA will arrange for a “courtesy fingerprinting” to be done.   Fingerprinting must be completed before the start of a student’s scheduled rotation.  As a note, this process takes a minimum of 4 weeks.

In accordance with new guidelines required by VA Human Resource Management Service, students must complete the entire VA packet and return it to the Medical Student Coordinator, Lacey Leonard, at the UCSF Fresno Center. 

The completed packet & student instruction sheet with ALL forms & documents should be MAILED to the following UCSF Fresno contact at least 4 weeks before the start of the scheduled rotation:

 

Lacey Leonard                                                              
UCSF Fresno Center                                                     
Undergraduate Medical Education Dept.
155 North Fresno Street, Suite 251
Fresno, Ca.  93701

(559) 499-6524

 

Send questions or comments to:
lleonard@fresno.ucsf.edu

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Additional VA contact information

Neurology Contact
Attn: Lucy Ramirez
VACCHCS-Fresno
Neuro/Rehab Service (127)
2615 E. Clinton Avenue
Fresno, CA 93703

Lucy.Ramirez@va.gov

Dermatology Contact

Melissa Gonzalez
VACCHCS- Fresno
Dept. 111
2615 E. Clinton Avenue
Fresno, CA 93703

Melissa.Gonzalez3@va.gov