Clinical UCLA Health Sciences Program: Required Assignment Forms

This page contains the Required Assignment Forms for the Clinical UCLA Health Sciences Volunteer/SRP Applicants. 

Please note, if you are a current Volunteer who needs to extend or renew their assignment, you will need to submit the same forms online through the Pre-Screening Application. 

Definitions:

• "Clinical Activities": activities that will involve ANY of the following:
• Patient or human research subject contact/interaction
• Access to or handle any identifiable/clinical/medical information
• Perform any duties involving activity within clinical settings and areas (i.e. hospital, clinics, waiting rooms, etc.)
• "Clinical Health Sciences Volunteers": You are a student or individual who is 18 years and older and will be volunteering your time to assist in clinical research/administrative projects without any form of compensation.
• "Clinical Research UCLA SRP Students": You are a current UCLA student who is 18 years and older and sponsored by a UCLA Health Sciences faculty to assist with Clinical Research under the Student Research Program (SRP) or other UCLA elective courses. Note: UCLA Students who are under the age of 18 and will be conducting research for SRP, your inviting faculty must submit a request for Exception to Policy for office approval.

Clinical UCLA Health Sciences Volunteers/UCLA SRP Students: (Must be 18 years or older)

If you are under the age of 18 years, please click here. 

Your inviting faculty/supervisor must complete and sign the following required Assignment Forms:

Inviting faculty/supervisors should read the Volunteer Guidelines before proceeding. 

Required Form #1: Volunteer/UCLA SRP Student Scope of Duties (VSOD) Form*

*Please see addendum forms below if applicable.

Required Form #2: Volunteer Personal Device Form

Please contact the coordinator at CRV@mednet.ucla.edu for assistance with creating your form and its addendum forms into one PDF.

If you need Adobe Reader to open PDF (Portable Document Format) files, please see free software from Adobe's webpage: https://get.adobe.com/reader/

Addendums: These addendum forms should be part of the VSOD Form to be uploaded or emailed to us separately (CRV@mednet.ucla.edu). 

• For Current UCLA Students ONLY: 
  • Volunteer Request High-Risk Lab Activities Form (VSOD Addendum)
  • Volunteer Request IRB Study Activities Form (VSOD Addendum) 
• If you will be assisting with more than ONE IRB study, please have your inviting faculty/supervisor complete the Volunteer IRB Listing (VSOD Addendum)
• If your assignment will involve assisting during MRI Scans as a Safety Second, please ensure an addendum is attached depending on the location of scanning:
  • Volunteer Duties for Brain Mapping Center (VSOD Addendum)
  • Volunteer Duties for Staglin Center (VSOD Addendum)

NOTE: Please submit your Online Pre-Screening and Assignment forms at least 2-3 weeks BEFORE your expected start date (typically the turnaround time to COMPLETE clearances is 1-2 weeks): ONLINE PRE-SCREENING APPLICATION (https://volunteer.healthsciences.ucla.edu/)

Please refer to the main Clinical UCLA Health Sciences Program Page for detailed instructions on how to submit the required Assignment Forms to initiate the clearance process.