APPROVALS Dean’s Office / IUSM Department / Dean’s Office for Medical Student Affairs / /
Position
Director Email / Course Director / Director / Chair / Course Director / and Faculty Advisor / Director of Medical Education / Chair / Faculty Advisor / Director Signature / /
Special Elective Request Form (for electives not in the IUSM Elective Catalog OR other LCME approved institutional catalog) Note: One Special Elective Request must be completed for each special elective requested Non-LCM