Application Checklist

Checklist of items to mail in:

  • Application form signed and imprinted with school seal
  • Washington State Patrol Disclosure Statement
  • Verified Credentials National Background Check
  • VA HIPAA Training Certificates (both Information Security and Privacy Policy Modules)
  • Copy of Personal Health Insurance Card
  • UW SOM Essential Requirements of Medical Education Form
  • UW Privacy, Confidentiality, and Information Security Agreement Form
  • Evaluation Form from Home School (not required)
  • UW SOM Immunization Form
  • Copy of BLS card (if not verified by school on application)
  • HIPAA Training Certification
  • Check for $100 Application Fee

Mail above documents to:

Visiting Student Program
UW School of Medicine
HSC-A300, Box 356340
1959 NE Pacific St.
Seattle, WA 98195




*please note that we need to receive the original application form with imprint of school seal by mail. Other documents can be faxed or emailed. It is highly recommended that all items be sent together in order to avoid delays in processing.