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Appendix I: Examinee Acknowledgement Forms

Incoming Students are required to sign and submit the following form

WR2 Curriculum
Case Western Reserve University
School of Medicine

Examinee Acknowledgement Form


I acknowledge that the curriculum unfolds at specified points in time.  Specifically, the learning objectives pertaining to small group cases are revealed at the end of each week’s deliberations.  I will not seek to obtain the case-specific learning objectives from students who have already completed the curriculum.  Looking forward, once I have completed the Year 1 curriculum, I will not provide case-specific learning objectives to future first-year students.

I hereby acknowledge that the Summative Synthesis Essay Questions (SSEQ) that I will be taking in the Foundations of Medicine and Health contain test materials that are owned and copyrighted by the Case Western Reserve University School of Medicine.

I hereby also acknowledge that I will be taking test materials that are owned and copyrighted by the National Board of Medical Examiners. 

I acknowledge that any reproduction of these materials, or any part of them, through any means, including, but not limited to, photocopying, downloading, and reconstruction through memorization, or dictation, and/or dissemination of these materials or any part of them, is strictly prohibited.

I further acknowledge that I will not retain, copy, or distribute any part of these secure examinations.

Name: ____________________

Signature: _____________________ Date: _________




Published and maintained by the Office of Student Affairs and the Academic Societies
Revised 3/03/17