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Forms

Program Updates or Changes

  • Participating Site Change Request
  • Complement Request Funding Form
    • ACGME – Requests for Changes in Resident Complement
  • Adding New Personnel or Changing Privileges in New Innovations
  • MD Anderson Rotation Request – UT Residents going to MDA
  • TMB Program Director’s Report
  • Contract Exception Request Form

New Programs

  • Program Letter of Agreement Template (PLA)
  • Application Process for New Training Programs
  • Application For Board-Approved Fellowship

Away Electives & Visiting Residents

  • Application for Away Elective Rotation
  • Pre-Registration for Visiting Resident
  • Out of State Visitor – Sample Program Director Letter to TMB

Interviews & Onboarding

  • Demographic Sheet for Interview Applicants
  • IMG Document Review Worksheet for Coordinators
  • IMG Document Review Worksheet for Applicants
  • Resident White Coat Order Form
  • Resident Parking Packet
  • Resident Sample Agreement

Graduates

  • UT GME Resident Checkout Form
  • HCHD Checkout Form

Program Tools & Resources

  • Moonlighting Request
  • Improvement Plan Table
  • Template Individual Learning Plan
  • UTHealth PEC Minutes Form

 Resident & Fellows

  • Anonymous Report of Resident Concerns & Duty Hour Violations
  • Reporting an Injury (Safety, Health, Environment, and Risk Management)
  • GME Fatigued Resident Travel Reimbursement Form (NOTE: You must also submit a completed and signed Self Attestation Form

Leave Requests

  • GME Leave Request
  • Family Medical Leave Forms
Office of Graduate Medical Education
at McGovern Medical School

Mailing Address:
McGovern Medical School at UTHealth
Office of Graduate Medical Education
6431 Fannin, Suite JJL 310
Houston TX 77030-1503

Physical Address:
McGovern Medical School at UTHealth
Office of Graduate Medical Education
1133 John Freeman Blvd., Suite JJL 310
Houston TX 77030-1503
Voice – 713-500-5151
Fax – 713-486-9534

 
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