Advisor Form Due: December 13th, 2010

STUDENT:

My career choice/s are:

As an advisor, I agree to:
 Discuss the elective schedule, make sure it is in compliance with the guidelines set
forth in the Electives Book - your advisee will have a hard copy and you can
access the information on the web:
http://www.med-ed.virginia.edu/handbook/electives.
 Be available for periodic reviews and to sign required Block Forms:
o Block A form due April 15, 2011; Block B form due August 8, 2011
and Block C form due December 5, 2011.
 Review the student’s Curriculum Vitae and Personal Statement.
 Be available to advise the student on questions about residency.

ADVISOR’S SIGNATURE:

Please print Name:

You only need to complete the following information for 1 advisee – thanks, Jill

Department:

Messenger mail address:

Phone: Fax:

E-mail: Date:

Orientation Meetings for Advisors will be held Friday, Jan. 7th from 12:00 – 1:00
and Tuesday, Jan. 11th from 5:00 – 6:00 in the Medical School Admissions
Conference room, 1st Floor Claude Moore Medical Education Building. Since
there have been many curriculum, calendar and scheduling changes, we strongly
encourage you to attend one of these meetings. Your ideas and concerns help us to
improve the electives program and assist new advisors.

I plan to attend the meeting on: January 7 ______ January 11 ______

______ I will be unable to attend the meeting, but will contact Jill Clarke, Electives
Coordinator (924-5579, med-electives@virginia.edu) or Dr. Meg Keeley,
Electives Director ( mmg4z@virginia.edu) when I have questions.
RETURN TO: Office for Student Affairs; PO Box 800739, Charlottesville VA 22908-
0739, (3rd Fl. Claude Moore Med-Ed Buidling, Suite 3188, Rm. 3129)
FAX: 982-4073