Medical Student Professional Responsibility and Criminal Record Disclosure Agreement

First Year Medical Student Professional Responsibilities and Disclosures Form

Last Name*
First Name*
Boston University Email Address*
Today's Date*
MM slash DD slash YYYY
Medical Student Professional Responsibility Agreement
Evaluation, Grading and Promotion of Students Policies
Medical Student Professional Responsibility Agreement*
- I have reviewed and understand the Medical Student policies posted above. I understand policies are subject to change at any time. I will review all policies on an annual basis.
Student Evaluation and Promotion Process*
- I have reviewed and understand Section 3 of the Medical Student Professional Responsibilities, outlining the Student Evaluation and Promotion Process.
Attendance, Time Off and Personal Days Policy
Attendance, Time Off and Personal Days Policy Agreement
Attendance, Time Off and Personal Days Policy Agreement*
- I have reviewed and understand the School’s attendance policy linked above. I understand policies are subject to change at any time. I will review all policies on an annual basis.
Criminal Record and Drug Screening Policy
Criminal Record Information Disclosure
Criminal Record Information Disclosure Agreement, Part I*
- I agree to notify the Associate Dean of Students Affairs of any felony or misdemeanor conviction in the United States or internationally since completing my medical school application.
Criminal Record Information Disclosure Agreement, Part II*
- I agree to notify the Associate Dean of Student Affairs of any future felony or misdemeanor conviction in the United States or internationally, up to and including graudation from the School of Medicine.
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