Incoming Trainee Checklist
Please ensure that all documents listed below are returned to your
coordinator along with this checklist no later than:
June 1, 2015
Name: _______________________________________________________________
Department: _________________________________ Start Date: _____/_____/_____
MEDICAL SCHOOL TRANSCRIPTS (select one)
These transcripts must bear the official seal, indicate type of degree and date the degree was conferred
All documents in a foreign language must be accompanied by an original translation
 Final transcripts are attached
OR
 Final transcripts are available and will be sent to coordinator or to Loyola’s
dedicated transcript email account (LOY-GMETranscripts@lumc.edu) directly
from the institution (Date of transcript request: _____/_____/_____)
OR
 Final transcripts will not be available by June 1st (current graduates only) A
request for final transcripts was submitted on: _____/_____/_____ and a copy of
the request is attached.
HUMAN RESOURCE DOCUMENTS
 Resident Employee Information Sheet
 Direct Deposit Forms
 Federal W-4 Form
 Illinois W-4 Form
 Dependent Verification
 Foreign National Form (for non-U.S. citizens only)
GRADUATE MEDICAL EDUCATION CONTRACT (select one)
 Signed contract is attached
 Signed contract was emailed to coordinator on ___/___/____
FOR PGY2 AND ABOVE TRAINEES ONLY



Copy of Certificate of Completion for any prior US GME training program(s)
Transfer Resident Evaluation Summary (if applicable)
OR
Current training extends past June 1st. and will end on ___/___/____.
Certificate of Completion and Evaluation Summary will be submitted to
coordinator as soon as they are available
Online Training Modules and Forms
 I understand that the following online training modules and forms must be completed prior to
the program start date: Annual Physician Safety Exam, Annual Disclosure Statement, Electronic
Medical Record (EPIC) Training, Trinity Health Confidentiality & Network Access Agreement.
Initial here: ____________
Updated: 2/17/16