Student Request for Clinical Clearance

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Complete this form if you have been offered a clinical internship position and you have been requested to submit vaccination, background check and/or drug screening clearances.

Student Information
Enter your information here:
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Site Information
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Some clinical sites will provide students with copies of the clearance forms and ask that they are given to a University representative. Please indicate if you have been given such forms.

Please link or upload copies of the forms your clinical site is requesting be completed and signed by a CSUF representative here.

More information
  • Files must be less than 100 MB.
  • Allowed file types: gif jpg jpeg png tif txt rtf html pdf doc docx xls xlsx.
More information
  • Files must be less than 2 MB.
  • Allowed file types: gif jpg jpeg png tif pdf doc docx.

After submitting this form, please wait for further instruction from a CICE Representative.

DO NOT begin your internship until you have been properly cleared to do so.