Dear Accepted Visiting Student,

Please complete this form and submit payment ONLY IF you've been instructed to do so by the UCSF Department Coordinator of your elective. All fields are required.

If you have been scheduled to do more than one elective at UCSF, please submit separate payments for each elective.

Please note that this Administration Fee is NON-REFUNDABLE!

If you have any questions about the payment form, please contact Visiting Student Manager Valerie Jones at Valerie.Jones2@ucsf.edu.

Thank you!
UCSF School of Medicine
Visiting Student Program