Non-Employee Associate Form (College of Medicine Only)
Instructions: After you fill this application the email will be send to Campus or Department for the appropriate approvals.
* I, a Non-Employee Associate of Drexel University College of Medicine (DUCOM), require account access to DUCOM services
("Account Privileges") because I am a(n)
Demographic Information
The following questions are optional but assist in reports that we are required to provide to various agencies
Contact and Work Information
Primary Work Address
Home Address
I understand that I am not an employee of Drexel University and therefore I am not entitled to compensation or
benefits of any kind, including, but not limited to, workers' compensation, unemployment compensation or health
insurance. I understand that in receiving Account Privileges, I agree to abide by all Drexel University policies and
procedures relating to the Services as may be in effect from time to time. Such policies and procedures can be found
at https://drexel.edu/hr/resources/policies/ and www.library.drexel.edu/about/librarypolicies.html. I further agree
that any violations of Drexel University's policies or procedures shall result in the immediate revocation of my
Account Privileges. I understand that my Account Privileges shall be reviewed on an annual basis.
By submitting this form you are acknowledging that all information is correct