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Education & Research > Trainee Programs > Scholars' Program > Scholars' Program Nomination Form - Pediatric Candidate (1)

Scholars' Program Nomination Form - Pediatric Candidate (1)

Thank you for your interest in the Scholars' Program. Please fill out the required information below.

Ensure that all documents are submitted in PDF format and contain no special characters in the file name, including punctuation.

NOTE: This online form must be completed in one single session. This form cannot save your information to return to at a later time.

RCPSC Gastroenterology Program Director Information

Pediatric Candidate (May Submit One)

Must be a Medical Student Y3-Y4 or Pediatric Program Resident PGY1-PGY3.

Candidate must also be a CAG member or have applied to become one by October 21.

Candidate Salutation
 Dr.
 Mr.
 Ms.
 Mrs.
 Mx.
Candidate Gender
 Man
 Woman
 Non-Binary
 Other:
Candidate is
 Medical Student    Resident (Pediatric)

Electronic Signature

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I also agree that the checkbox and my name typed below are to be used as my electronic signature.

I certify that the above information is true and correct and that I am the person completing this form.

 Yes  

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