UME - AER Award in the Schulich School of Medicine & Dentistry
UME - AER Award in the Schulich School of Medicine & Dentistry
Fields denoted by an asterisk (
*
) are required.
Have you submitted a financial assistance application for this academic year through the Student Center by the September 30th deadline? *Please note: If you have not submitted this application, you will not be eligible for this award.
*
Have you submitted a financial assistance application for this academic year through the Student Center by the September 30th deadline? *Please note: If you have not submitted this application, you will not be eligible for this award.
Yes
No
Only students that have applied for financial assistance with the student centre by the Sep 30th deadline for each academic year will be considered for this award.
Name of Applicant:
Name of Applicant:
*
First
Last
Email of Applicant:
*
Program Location of Applicant
*
London
Windsor
Describe the type of elective you plan on taking,
including the department and any sub-specialties
.
*
Maximum of
500
words allowed.
Currently Entered:
0
words.
Please select your proposed Elective Start Date:
Please select your proposed Elective Start Date:
/
DD
/
MM
YYYY
Please detail the City, Province & Country of the elective you plan on taking.
*
Is the location of your elective underserviced?
*
Is the location of your elective underserviced?
Yes
No
Please describe:
*
Maximum of
250
words allowed.
Currently Entered:
0
words.
Please provide an estimate of accommodation expenses for your proposed elective.
*
Maximum of
250
words allowed.
Currently Entered:
0
words.
Please provide an estimate of transportation expenses for your proposed elective.
*
Maximum of
250
words allowed.
Currently Entered:
0
words.
Briefly explain why you are interested in participating in a clinical placement outside your program location, and how you believe it will contribute to your development as a physician:
*
Must be between
250
and
1500
words.
Currently Entered:
0
words.
Please provide us with a copy of your CV (PDF Only):
*
Attach Files
Additional Comments
Maximum of
100
words allowed.
Currently Entered:
0
words.