Please schedule an appointment with your OSA Advisor to complete this form in person.
Click here for a printable version of this form
PETITION TO DECELERATE
FORM SHOULD BE COMPLETED PRIOR TO APPOINTMENT WITH DEBORAH ANDERSON
DATE:
NAME:
Original expected date of graduation:
Proposed date of graduation:
Reason for deceleration:
Use reverse side of form if necessary.
Do you plan on receiving financial aid for each quarter of your extra
year? You must register and enroll in classes for each quarter in which
you receive financial aid. Please note that your eligibility for financial
aid may change if you decelerate, and your ability to receive financial
aid is not a given.
On page 2, indicate how you will use the extra year, i.e., ISP, clerkships
away - what, where, and when? Some away clerkships require faculty approval
in advance (signed extramural form -- available in the OSA) in order for
you to receive credit. You must enroll in courses and pay fees at UCSD
during the quarters you are away to receive academic credit and to be covered
for malpractice. OSA must receive written confirmation of your away clerkships.
It is your responsibility to have the evaluations sent to the OSA immediately
following each away clerkship.
If you are decelerating your graduation to obtain and M.P.H. degree,
state where you will go for this degree, and the length of time necessary
to complete M.P.H. degree requirements. Explain how you will interdigitate
M.P.H. and M.D. requirements. Note that one of the requirements for the
M.D. degree from UC San Diego is 13 quarters of full-time enrollment in
the School of Medicine. The above statement should be attached to this
petition.
What are your plans for health insurance coverage? NOTE: If more than
one quarter of the extra year is "off", you must petition for a Leave of
Absence for the "off" periods. Forms are available in the
OSA.
