Please use this form to notify the Dean's Office of Requests for New Accounts, changes to Evaluators, Site Directors, Clerkship Chairs, Coordinators, Residency Program Directors, and Residency Program Administrators.

The LCME, our accrediting body, requires that a medical school ensures that supervision of medical student learning experiences is provided throughout required clerkships by members of the school's faculty or the individual operates under a member of the UCLA faculty. 

If you search for an evaluator within MyCourses and are unable to find them within the system, you must verify that they either have a UCLA faculty appointment, have resident/fellow status, or operates under a member of the UCLA faculty (e.g., a Site Director who has a UCLA faculty appointment). Please partner with the Academic Personnel in your Department to verify this information before submitting the form below. 

If the individual does not have a faculty appointment or does not operate under a UCLA faculty member, the Clerkship Chair can work with their Department Chair to pursue a faculty appointment through the department. Please note, this option may take some time and the instructor should not be given supervisory or assessment capabilities until a UCLA faculty appointment is confirmed. Once the faculty appointment or resident/fellow status have been confirmed, please complete the form below to have the Dean's Office add the evaluator into our assessment and evaluation systems. 

 To help keep our evaluator records up to date, please submit a request to remove evaluators as appropriate.




Choose one or more options to request changes: