Name:*
Address:*
Telephone:*
-
E-mail:*
Select Training Site:*
Other Training Site:

IN CASE OF AN EMERGENCY - If you would like us to contact someone on your behalf, please provide the following:

Emergency Contact Name:
Emergency Contact Telephone #:
-
Emergency Contact Email:

Clinical Candidates Examination Fees:

  • $ 4,155 Written & Comprehensive Objective Examination (includes both written and oral/osce components).
  • $ 650 Exam Processing Fee
  • Total $4,805

Both the written and oral examination fees are due January 15, 2018.  Fees are in CDN funds.

Payments are accepted by cheque or money order payable to the CCMG and sent to: CCMG 4 Cataraqui Street Suite 310, Kingston, ON K7K 1Z7


Clinical Examination*

WRITTEN EXAMINATION – May 1 & 2, 2018

Language of Written Examination :

OSCE EXAMINATION - MAY 19, 2018 (La Cité Collégiale, 801 Aviation Parkway, Ottawa)

Language of Oral Examination:

*If you are sitting the written examination, you must designate an adjudicator who agrees to the following:

  • will be responsible for receiving the examination package;
  • will adjudicate the examination;
  • will guard the confidentiality of the examination;
  • will return the examination to the Chairperson of the Examinations Committee. 

Unless specific alternate arrangements have been made through the CCMG Management Office, the adjudicator must be a Fellow of the CCMG.

Name of Adjudicator: (Instructions and the examination package will be mailed to the adjudicator by May 1.)
Signature:*
Date:*

THIS COMPLETED FORM WITH YOUR EXAMINATION FEE PAYMENT MUST BE RECEIVED BY THE CCMG OFFICE BY THE JANUARY 15, 2018 DEADLINE.

Total: