CLINICAL/RESEARCH FELLOWSHIP Reproductive Sciences

PROGRAM(S) APPLYING FOR DURATION SUPERVISOR (if known) HOSPITAL (if known) Reproductive Sciences ____________ ____________________ _____________ Basic Research ____________ ____________________ _____________OTHER PROGRAM(S): ________________________ ____________ ____________________ _____________ ________________________ ____________ ____________________ _____________Proposed Start Date:(Day/Month/Year)Proposed End Date:(Day/Month/Year)INITIAL application requirements that MUST accompany application - subject to change without noticeFor graduates of an acceptable medical school Outside CanadaAnd the United States of America (USA)Please check (3) off and enclose with application: Up-to-date detailed curriculum vitae Letter confirming funding support (if being sponsored or self-funded)2-3 letters of referenceCopy of specialty certification from your country’s CertifyingBoard OR a legible photocopy of an Official Letter or Certificatefrom the Board confirming that you have satisfied the trainingrequirements for certification as a specialist and expected date ofcertification (with English translation, if applicable)Copy of Medical Degree (with English translation if applicable)A personal letter stating applicant’s goals and objectives forfellowshipMedical Council of Canada Evaluating Exam if appointment is formore than 2 yearsTOEFL (580 or more), TSE (50 or greater or greater of 237 oncomputer-based test (not applicable to Research Fellowship appointments)Graduates of Accredited Medical Schools In CanadaOr the United States of America (USA)Please check (3) off and enclose with application: Up-to-date detailed curriculum vitae Letter confirming sponsorship support (if applicable)2-3 letters of referenceLegible photocopy of a certificate or letter confirmingspecialty certification. OR if enrolled in residencyprogram, letter from Program Director confirmingstatus in Residency Program.Copy of Medical DegreeA personal letter stating applicant’s goals andobjectives for fellowshipRecent photo (optional)∗∗If you wish clarification on any of the above, please contact Ms. Mary Miceli at 416-978-6830 or e-mailmary.miceli@utoronto.caAdditional information required from applicant after they have been offered a position.Outside Canada and the USA Signed Statement of Intention to return to your home country (supplied by U of T) Visa processing fee of $150.00 Canadian in the form of a cheque or Money Order Recent photo (optional)In Canada or the USA Copy of Medical Transcript Immunization Record(Applicant's name - please print) (Applicant's signature) (Date)Approvals: _______________________________(Clinical/Research Fellowship Director)_________________________________(Department’s Program Director)Educational Goals and Objectives for Reproductive Endocrine and Infertility Fellowship