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Visiting Clinical Professorship Nomination Form

 

Thank you for your interest in the Visiting Clinical Professorship. 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.

Nominator Information

Please enter the nominator's first name
Please enter the nominator's last name
Please enter the nominator's street address
Please enter the nominator's city
Please select a province
Please enter the nominator's postal code
Please enter a valid email address
Please enter the nominator's phone number
Please select one option

Nominee Information

Please enter the nominee's first name
Please enter the nominee's last name
Please enter the nominee's street address
Please enter the nominee's city
Please select a province
Please enter the nominee's postal code
Please enter a valid email address
Please enter the nominee's phone number
Please select one option

Required Documentation

Note: Files must be in .PDF format.

Please upload a .PDF file with no special characters in file name
Please upload a .PDF file with no special characters in file name

Please ensure that all required fields are filled out correctly.

Upon successful submission, you will be redirected to a confirmation webpage and will receive an email from us. If this does not occur, please contact the CAG National Office.

NOTE: Do not close your browser or use the back button until redirected to the "Thank You" screen, confirming successful submission. Uploading large files may take a minute or so.

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