Enhanced Skills Application Form – IMG Applicants | Family Practice Residency Program

Enhanced Skills Category 2 Application - IMG

Personal Information
Name
First Middle Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone
Birthdate*
DD slash MM slash YYYY
Medical School and Year of Graduation*
Location of Family Medicine Residency Training, and Year of Graduation:*
College of Physicians & Surgeons License#*
Canadian Medical Protective Association (CMPA)#*
Country of Citizenship*
If not a Canadian citizen, please complete:
- Landed Immigrant/Permanent Resident
- Working Visa
- Certified Refugee
- Other
Program Application Information
Please note that all training will be a maximum of 3 months in length, and will take place from January - March, 2022.
Requested Training Area*
Please select the Category 2 Program you would like to apply for. If you do not see the program you are interested in, or if you would like to self-design, please choose 'Other' and fill in the question below.
Other/Self-Design
If you have selected 'Other' in the question above, please describe what kind of training you are interested in.
Requested training length (minimum 6 weeks, maximum 12 weeks):
Preferred training location/preceptor (if applicable):
Personal statement:*
Please outline why you are interested in this program and what you wish to accomplish.
Please upload a current CV*
Drop files here or

Max. file size: 20 MB.
Letters of Reference
We require 2 personal reference letters to support your application. Please have your referees submit these letters directly to the Enhanced Skills office via email: lindsay.gowland@familymed.ubc.ca
Letter from the Ministry of Health
We require 1 letter from the Ministry of Health, authorizing the release of the resident from their Return of Service agreement for a period of up to 3 months Please have your referee submit these letters directly to the Enhanced Skills office via email: lindsay.gowland@familymed.ubc.ca
Letter of Community Support
We require 1 letter of community support. This is a letter from someone in the community (hospital Chief of Staff, Chair of the CHC etc.) clearly identifying the community need and confirming the willingness of the community to utilize the skills of the physician once acquired. Please have the referee submit it directly to the Enhanced Skills office via email: lindsay.gowland@familymed.ubc.ca
Letter from Previous Family Practice Site Director
Please have your previous Family Practice Site Director provide a letter confirming the completion of the residency program in good academic standing . Please have the referee submit it directly to the Enhanced Skills office via email: lindsay.gowland@familymed.ubc.ca
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Enhanced Skills Application Form – IMG Applicants

Enhanced Skills Category 2 Application - IMG

Personal Information

Program Application Information

Letters of Reference

Letter from the Ministry of Health

Letter of Community Support

Letter from Previous Family Practice Site Director