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Postgrad Application Form

Personal Information

Gender
Stream

Current Address

Is your current address the same as your permanent address?

Permanent Address

School Information

Medical School
Current Status
Status at time of rotation

Placement Information

Rotation Information
Length of rotation (Number of weeks)
Do you give ERMEP permission to choose a location if your choices are not available?
Do you have a vehicle
Do you require accommodations?
Do you have any pet allergies?
Does ERMEP have your permission to use your photograph in published articles, newsletters, flyers, posters, brochures and presentation materials?

The Eastern Regional Medical Education Program [ERMEP] along with the Distributed Medical Education [DME] considers it unprofessional to cancel a rotation once a preceptor is confirmed. ERMEP considers it a breach of professionalism when the learner cancels without a valid reason less than four weeks from the start date of the rotation. ERMEP will then report this to the schools and ask that they deal with this as unprofessional behavior. It is important to recognize that preceptors are often very annoyed by late changes due to their scheduling requirements. Accommodation cancellations must be made through ERMEP a minimum of four weeks prior to placement start date. By submitting this application, I agree to abide by all of ERMEP policies and confirm that I have not applied to any other Networks. I understand that once the Eastern Regional Medical Education Program has contacted me with the name of a preceptor, it is unprofessional for me to cancel the rotation. I acknowledge that ERMEP will notify my school of any unprofessional behaviour.

I agree to cancellation policy
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