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
  Moose Factory Program
  NOMEC
  NOSM
  ROMP
  SWOMEN
  CFMS/IFMSA

 

  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:

 

Email to Student
Email to Organization (cc'd to Student)
Fax

 

Other Comments (max 150 Characters):