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Immunizations Required

  • Updated Tetanus and Diphtheria
  • HBV (Hepatitis B)
  • MMR
  • Current PPD/TB
  • Varicella
  • Tdap (Tetanus, Diptheria, Pertussis) – Get either a Td or Tdap booster shot every 10 years after first dose)
  • Influenza by November 30th of each year
  • Covid-19 Vaccine and booster
  • Student to keep originals of all documents and have them available in case they are requested.

Immunizations Records Submit to and Date:

  • If complete, acceptable if on file at Berkeley Optometry.

Documentation Required

WOC Application Package

A list of the application packet forms with some helpful notes is as follows:

  • The entire packet needs to be printed out and all signatures must be original in ink; no electronic signatures will be accepted.
  • Mail or fax the packet single sided.
  • If you are mailing the packet, do not fold the pages of the packet in an envelope if you are mailing them; the pages must remain flat for scanning purposes.
  • Applications without a valid Social Security Number (SSN) cannot be processed; please attach your F-1 Visa form or green card if you are not a US citizen/
  • Refer to the guidelines below for each of the forms so you can complete them correctly.
  1. VA Form 10-2850D Application for Health Professions Trainees
    a. For Item 7B and 7C ‘VA Training Start Date’ and ‘VA Training End Date’, please enter the dates of your rotation as a two digit month and four digit year; do not select the box that says ‘Unknown’ on page 1
    b. Leave Section IV blank on page 1
    c. Ensure that your full legal name & SSN appear at the top of pages 2-4
    d. In Section VII, please list your undergraduate degree(s) and your optometry degree in progress on page 2
    e. Sign block 24A and date in block 24B on page 3
    f. Don’t forget to fill out, sign, & date page 4
  2. SF 61 Appointment Affidavit
    a. Do not put a date on the line above (Date Appointed) in the upper right corner
    b. Type your name on the line following “I, ___”
    c. Sign just below item C
    d. Do not fill in anything below your signature, below item C.
    e. The form does not need to be notarized
  3. OF 306 Declaration for Federal Employment
    a. In Item 1, please list your full legal name (First, Middle, Last); if you have no middle name please list “NMN” (no middle name)
    b. In Item 5, list any other names used (First, Middle, Last)
    c. Sign on line 17a Applicant’s Signature; do not sign line 17b Appointee’s Signature
  4. HR letter
    a. Put your full legal name and address at the top where it says Name/Full Address
    b. In the box “Dear ___________”, type your full legal name
    c. In the box “Optometry Extern from ________ through _________”, put the dates of your rotation as a two digit month and four digit year
    d. Circle veteran status at bottom of letter (above signature)
    e. Sign and date at the bottom of the letter
  5. WOC Intake Form
    a. Add the date at the top of the letter where it says “Date:”
    b. For US CITIZEN question, if you mark NO then you must provide a copy of your visa or green card as part of the application
    c. For DATES OF APPOINTMENT and DATES OF TRAINING, put the dates of your rotation as a two digit month, two digit day, and 4 digit year
  6. VA Rules of Behavior
    a. Sign and date on page 3
  7. VA Random Drug Testing Notification
    a. For Training Program and Affiliate type the following: SAVAHCS Optometry Externship affiliated with Berkeley College of Optometry
  8. Request for VA Identification Card
  9. ADPAC survey/VA rotations questionnaire
    a. Please list any VA rotations prior to or following your rotation at VA Casa Grande
  • After completion, please send back to Dr. Carla Engelke by March 1st in the spring of 3rd year of Optometry School either by mail or fax listed below:Mail: Carla Engelke, OD
    SAVAHCS, Eye Clinic
    3601 S 6th Ave (11-112A)
    Tucson, AZ 85723
    Email: Carla.engelke@va.gov
    FAX: (520) 629-4808
  • Updated contact info under security and access: Any questions or concerns: Computer/Portal/TMS please contact Wayne Anderson at hubert.anderson@va.gov, or call him at 520-792-1450 x 1-5775
  • International Students and Social Security Numbers:
  • Health professions trainees (HPTs) training at VA medical centers receive temporary Federal appointments and personal identity verification credentials. To be properly vetted and eligible to participate in training, non‑US citizen HPTs who are temporarily in the United States must have:
  • A nonimmigrant F-1 or J-1 student classification; or, an I-20 (or DS-2019) certificate of eligibility; AND
  • A US Social Security Number
  • Unfortunately the use of a “pseudo-SSN” is prohibited in certain Federal systems. Your facility may have found work arounds, however use of a pseudo-SSN, or other 9-digit number, will not be permitted after May 1, 2018. Therefore, we are notifying the field in advance of this change in the onboarding process for non-US citizen trainees.
  • View the complete information from the Social Security Administration here.
  • For travel insurance coverage, please register all out-of-state travel at the UC Trips website to ensure coverage for each covered off-campus activity. You are covered from the time you start your travel to the rotation, through your rotation, and through your return trip.

Documentation Submit to and Date

  • ALL students are to complete and submit the WOC application package by March 1st in the spring of 3rd year of Optometry School by mail or fax to Carla Engelke, OD, SAVAHCS, Eye Clinic, 3601 S 6th Ave (11-112A), Tucson, AZ 85723
RequirementDeadlineReturn
WOC Application Packet3/1/2024Return to Dr. Engelke by mail or fax (520-629-4808), single sided only
Fingerprinting instructions
Fingerprinting locations
No earlier than 120 days prior to 1st day of rotation and no later than 60 days prior to 1st day of rotationE-mail Dr. Engelke at Carla.Engelke@va.gov when completed with date and location
TMS Mandatory Training for Trainees (MTT) certification, online course 60 days prior to 1st day of rotationE-mail Dr. Engelke at Carla.Engelke@va.gov certificates when completed

Mandatory Training for VA Health Professions Trainees

Instructions

Security and Access

  • VA Identification Badge (PIV): You will need a PIV card for computer access and identity verification at every VA facility.
  • If you do not already have a PIV card and have completed your fingerprints, Dr. Rhodes will schedule an appointment to have your photo taken (Initial PIV registration) on your first day of orientation at SAVAHCS.
  • You will need to bring two forms of government ID’s (not copies).
  • If you already have an active VA issued PIV card, you are not required to receive a new badge but will need access changed on card. Please bring the card with you on your first day and we will facilitate this.
  • You will, however, need to make sure your fingerprints were taken no more than 120 days and no less than 60 days prior to the first day of your VA Casa Grande rotation (additional details below).
  • Fingerprinting: Due to a Federal mandate, students must be fingerprinted prior to their arrival at VA Casa Grande. If you will not be connected to a VA hospital prior to your rotation and/or have not had your fingerprints done at a VA facility 120 days prior to your rotation start date, you are required to complete them at least 60 days prior to your first day at SAVAHCS campus.
    • Fingerprinting instructions and locations are here.
    • Fingerprints must be taken at a VA location
    • Please email Dr. Engelke once completed including date and location that fingerprints were taken
    • If you are connected to a VA hospital prior to your rotation through Tucson, please e-mail Dr. Engelke when and where your fingerprints were taken.
    • You can be fingerprinted at VA San Francisco or VA Martinez.

VA San Francisco

    • The office hours are Mondays through Fridays from 8 a.m. – 11 a.m. and 1 p.m. – 3 p.m.
    • Please make an appointment in USAccess according to the instructions on the fingerprinting instructions document and forward the appointment email to Dr. Engelke so she can get you sponsored in the USAccess system.

Please bring 2 original and current forms of ID (one must be a Government-issued photo ID) and your completed Fingerprinting Form to your appointment.

 

VA Martinez

  • VA Northern California Health Care System Martinez – PIV Office, 150 Muir Road, Bldg. 21 Rm 219, Martinez, CA 94553, (925) 372-2000, ext. 6755. The PIV office is located inside Bldg. 21 on the second floor in room 219. Customer parking is located in the large gravel parking lot, across the street from Bldg 21. Click for map of VA Martinez PIV Office.
  • Open Monday through Friday 8:30 to 12 p.m 1-3 p.m. Closed for lunch between 12 and 1 p.m.
  • Please make an appointment in USAccess according to the instructions on the fingerprinting instructions document and forward the appointment email to Dr. Engelke so she can get you sponsored in the USAccess system.
  • You can make an appointment by emailing v21pivmartinez@va.gov. In the subject line, please indicate for “Fingerprinting.” In the message, please provide:
    • first name and last name
    • phone number
    • email address
    • three dates and times that work for you.
      They will reply to confirm the date of your appointment.
  • Please bring 2 original and current forms of ID (one must be a Government-issued photo ID) and your completed Fingerprinting Form to your appointment.
    • Click here for Acceptable IDs.
    • The completed fingerprinting form. Please provide the SOI and SON (see below) of the VA that you need the fingerprints for so that they know where to send the results.
    • This must be done NO GREATER than 120 days before the start of your rotation and NO LATER than 60 days before the start of your rotation. You can provide the VA where you are fingerprinted the following information:
    • SAVAHCS Fingerprints
    • SOI# VAE9
    • SON# 1438
    • Organization: VHA
    • Employee type: Student/Trainee or Affiliate (if Student/Trainee option is not available)
  • Be sure to bring two picture IDs such as Driver’s License, Passport, School ID to the appointment.
  • Inform Dr. Engelke of your fingerprint date and location.
  • If you are not connected to a VA hospital and/or have not had your fingerprints done at a VA facility within the past 120 days of your rotation date, you are required to complete them 60 days prior to your first day at SAVAHCS campus and Dr. Rhodes will schedule your photo on your first day of orientation. Please review Identity Documentation Criteria for badging.
  • The following documents should also be reviewed:
    • Any questions or concerns: Computer/Portal/TMS please contact Wayne Anderson at hubert.anderson@va.gov or call him at 520-792-1450 x 1-5775.

Absence Policy

Personal leave is not granted during your fourth year with the exception of the following:

  • NBEO Boards:
    1. Leave requests should be submitted in writing (e-mail is acceptable) to Dr. Rhodes at least 30 days in advance of the days to be taken.
    2. Prefer day of test to be on a Monday or Friday or federal holiday.
    3. No requests for NBEO III leave will be granted for the first week of the rotation.
  • Residency Interviews
  • Academic Meetings: Students may be excused to attend a national optometric meeting with prior approval from Dr. Rhodes.
  • Federal Holidays: Dr. Rhodes will announce all observed holidays at the beginning of the quarter.
  • Professional Activities: At the discretion of Dr. Rhodes, activities that enhance professional development or are required for future residency/fellowship training or employment may also be considered.