Care Extender Forms

Forms for UCLA Care Extender Program  

The Leave of Absence form should be submitted to the Leave of Absence Coordinator, Benjamin Chiang, at BChiang@mednet.ucla.edu. The Change of Information form and TB questionnaire should be submitted to the Administrative Coordinator, Alexis Sherer, at CEAdmin@mednet.ucla.edu. The Extension Request form and Reorientation Quiz should be submitted to the Extension Coordinator, Alexis Sherer, at CEAdmin@mednet.ucla.edu. The Inactivation/Completion Request form should be mailed along with your volunteer ID badge to the Care Extender Office.