School of Medicine
Faculty of Health Sciences Queen's University
 
Undergraduate Medical Education

Letter of Good Standing Request Form

OUTSIDE CANADA
***Letters of Good Standing will not be processed until all documentation has been submitted for approval. Further information can be found at http://meds.queensu.ca/current_students/international_activity***


* Student First Name:
* Student Last Name:
Graduation Year:
*Queen's Email Address:
Date of intended activity:        

Organization requesting confirmation of student standing:

General

Bank
International Opportunity
  Student Discount (no mention of insurance)
Elective or Observership
KGH Surgery (no contact info required below)
Regional Community Rotation (insurance confirmation and immunization records required)

 

OR...

Program Provider :

ERMEP - Sandra Whan
Moose Factory Program - Candy Crouchman
NOMEC - Sherri Moroso
NOMP - Karen Stasus
ROMP - Caitlin McCullam
SWOMEN - Brenda Arnold
  CFMS/IFMSA - Terry Wuerz

 

None of these apply - please complete contact information below:

ORGANIZATION CONTACT INFORMATION: (Required fields are marked with '*'. Please provide as much info as possible.)

Organization:
Supervisor/Administrator:
* Address Line 1:
Address Line 2:
* City:
* Prov/State/Country:
* Postal Code:
Phone:
Fax:
Email:

Method of Delivery:

 

Mail
Fax
Pick-up

 

Other Comments (max 150 Characters):

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