Observership Program Application –¬†Applicant’s Information

Please complete the entire form and payment. Have all necessary documents ready to upload.


















MaleFemale

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EDUCATION / TRAINING:






MDMedical Student

INTERNATIONAL MEDICAL GRADUATES ONLY:


NoYes

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***REQUESTED ROTATIONS:***
***Observership Specialties***

Your FIRST Choice

Your SECOND Choice

Your THIRD Choice



When would you like to start your Observership Program?





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***INMIGRATION:***

Permanent ResidentVisitor's (B-1 / B-2) VisaJ-1 VisaH-1b / H-4 VisaUS CitizenO-1 VisaF-1 Student Visa










***HEALTH REQUIREMENTS:***
Visitors are required to provide proof of immunization, specifically:

1. Varicella, Rubella, Measles: Vaccinated (or) Titers showing immunity (<10 years)
2. Tuberculosis: PPD negative (or) Chest X-ray negative (<1 year)
3. Proof of hepatitis B immunity (serology)

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***DECLARATION:***
I certify that the information given on this form is true, accurate and complete. I understand that any false information will cause my disqualification.


I Accept this declaration

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IN ORDER FOR FMGCT TO SECURE YOUR 4 WEEK ROTATION, APPLICATION FEE ($299) AND VALID ONLINE APPLICATION MUST BE SUBMITTED.