DGSOM at UCLA Affiliation Agreement Request Form Logo
  • AFFILIATION AGREEMENT REQUEST FORM

    Request forms should be submitted at least 90 days prior to the proposed effective date of the agreement. In rare instances, affiliation agreements may take 6+ months to process.
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  • DGSOM at UCLA Administrator/Requestor Information

  • Onboarding

    Please keep in mind that many sites require a 60-day lead time for onboarding.
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  • Facility/Affiliate Information

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