International Clinical Electives

Visiting Student Checklist

First Name: _________________________________ Surname: ___________________________________

TO BE ELIGIBLE, A STUDENT MUST:

 At the time of the elective, be in the final year of medical school and have completed all core clerkships.
 Submit verification of completion of core clerkships in each of the following disciplines, indicating the number
of weeks completed (Family Medicine/Primary Care, General Internal Medicine, Obstetrics/Gynecology,
Pediatrics, Psychiatry, and General Surgery).

ATTACH THE FOLLOWING DOCUMENTS:

 RCSI Visiting Student Checklist Signed

 RCSI Application for Clinical Elective
 Official Letter of Support on your school's letterhead (letter of good standing)
 Official Transcript of Results
 Copy of Criminal Background Check/Irish Garda Clearance

In addition, the following documents must be signed and stamped by a professional:

 Evidence of vaccinations:
ESSENTIAL
• Hepatitis B, including anti-HBs Ab (minimum titre ≥ 10 mlU/mL).
• MMR (2 DOSES) or serological evidence of immunity.
• Evidence of BCG vaccination, alternatively a negative PPD or QuantiFERON test.
• Evidence of MRSA negativity (within 3 months).
• Evidence of DTaP vaccination (within 10 years).

DESIRABLE
• Hepatitis C vaccination
• Copy of lab report: Varicella Zoster
• Copy of lab report: Meningitis test
• Meningitis C vaccination

 Proof of Personal Health Insurance coverage.

 Proof of Medical Malpractice Insurance coverage. Coverage must be worldwide and meet the following
criteria:
• Minimum €1,000,000 per one claim.
• €3,000,000 in the aggregate for the period of insurance, including costs.

 Copy of most recent CV.

 Application Fee (required when clinical placement is approved).
 International students only: IELTS or TOEFL Score Report, or evidence that the course of study is taught and
assessed in the English language. MINIMUM required scores are:
• IELTS: Overall average score of 6.5 with no individual section lower than 6.0.
• TOEFL: 79 – 93+.

In signing this document, I undertake to maintain strict confidentiality of all patient records entrusted to me during this
rotation.
I agree that RCSI may process personal data contained in this form, or other data which the University may obtain
from me or other people whilst I am an applicant, for any purposes connected with my application or for any other
legitimate reason.

Student Signature: _______________________________________ Date: __________________