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    Medical STD

    Uploaded by

    Nasir Iqbal
    This document is an application form for medical student electives at the Shaukat Khanum Memorial Cancer Hospital & Research Centre. It requests information such as the applicant's name, date of birth, nationality, address, phone number, email, educational institution, preferred medical discipline, requested elective dates, and accommodation requirements. The applicant must be in their final year of study and the elective placement must be a minimum of 2 weeks and maximum of 8 weeks. The applicant's educational institution must fill out a section confirming their academic standing and the objectives of the elective. Documentation that must be attached includes photos, ID, educational degrees/transcripts, and a letter confirming student status. Application fees vary based on domestic or international applicant

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    Medical STD

    Uploaded by

    Nasir Iqbal
    42 views2 pages
    This document is an application form for medical student electives at the Shaukat Khanum Memorial Cancer Hospital & Research Centre. It requests information such as the applicant's name, date of birth, nationality, address, phone number, email, educational institution, preferred medical discipline, requested elective dates, and accommodation requirements. The applicant must be in their final year of study and the elective placement must be a minimum of 2 weeks and maximum of 8 weeks. The applicant's educational institution must fill out a section confirming their academic standing and the objectives of the elective. Documentation that must be attached includes photos, ID, educational degrees/transcripts, and a letter confirming student status. Application fees vary based on domestic or international applicant

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    nuclear medicine

    Original Title

    Medical Std

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    This document is an application form for medical student electives at the Shaukat Khanum Memorial Cancer Hospital & Research Centre. It requests information such as the applicant's name, date of birth, nationality, address, phone number, email, educational institution, preferred medical discipline, requested elective dates, and accommodation requirements. The applicant must be in their final year of study and the elective placement must be a minimum of 2 weeks and maximum of 8 weeks. The applicant's educational institution must fill out a section confirming their academic standing and the objectives of the elective. Documentation that must be attached includes photos, ID, educational degrees/transcripts, and a letter confirming student status. Application fees vary based on domestic or international applicant

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    42 views2 pages

    Medical STD

    Uploaded by

    Nasir Iqbal
    This document is an application form for medical student electives at the Shaukat Khanum Memorial Cancer Hospital & Research Centre. It requests information such as the applicant's name, date of birth, nationality, address, phone number, email, educational institution, preferred medical discipline, requested elective dates, and accommodation requirements. The applicant must be in their final year of study and the elective placement must be a minimum of 2 weeks and maximum of 8 weeks. The applicant's educational institution must fill out a section confirming their academic standing and the objectives of the elective. Documentation that must be attached includes photos, ID, educational degrees/transcripts, and a letter confirming student status. Application fees vary based on domestic or international applicant

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    © All Rights Reserved
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    Shaukat Khanum Memorial Cancer Hospital & Research Centre

    Medical Student Elective Application


    FIRST NAME: ________________________

    MIDDLE INITIAL: _______________

    LAST NAME: ________________________


    DATE OF BIRTH: _____________________

    SEX: _____________

    NATIONALITY: ______________________
    ADDRESS: ____________________________________________________________________________
    CITY: __________________

    COUNTRY: ________________

    TEL.________________________

    POSTAL / ZIP CODE: ___________

    MOBILE/CELL #: ____________________________

    EMAIL (Please print): ___________________________________________________________________


    CURRENT EDUCATIONAL INSTITUTION: ________________________________________________
    REQUESTED DISCIPLINE (Rank in order of preference, from 1 to 5 with the first preference ranked as 1)

    Anesthesia

    Internal
    Medicine
    Peadiatric
    Oncology
    Clinical
    Research

    Pathology
    Basic Science

    Medical
    Nuclear Medicine
    Oncology
    Radiation
    Radiology
    Oncology
    Surgical
    Clinical
    Oncology
    Psychology
    Other _______________________

    Hospital Medicine
    Requested Electives dates: From ___ /___ /201 __

    To

    ACCOMMODATION REQUIRED (Rooms assigned based on availability):

    ___ /___ /201 __


    (1) NO

    (2) YES,

    APPLICANT'S SIGNATURE: ____________________________ DATE: ________________________

    For HRD use only:

    Received at HRD on: ___/___/_____

    Application Dates (dd/mm/yyyy): ___/___/_____

    to___/___/_____

    Department:_______________________

    HoD Approval:_________________________

    HoD Comments (if any):_________________________________________________________________

    Remarks Observations: ____________________________________________________


    Check List:
    Offer Letter

    Terms & Conditions

    HRD (EEO-SEA 2010)

    Evaluation Form

    Shaukat Khanum Memorial Cancer Hospital & Research Centre


    Medical Student Elective Application
    TO BE COMPLETED BY SENIOR INSTITUTIONAL OFFICIAL (i.e. Principal, Dean, or
    equivalent)
    This is to recommend the applicant for an elective at the Shaukat Khanum Memorial Cancer Hospital and
    Research Centre for the above dates. This certifies that the applicant is in good academic standing at our
    institution and that the information supplied here is complete and accurate, to the best of my knowledge.
    Electives objective by institutional head.
    ______________________________________________________________________________________
    ______________________________________________________________________________________
    ______________________________________________________________________________________

    CURRENT ACADEMIC STANDING of APPLICANT (GPA or Equivalent) ______________________


    NAME OF DEAN/OFFICIAL: ________________________________________
    SIGNATURE & STAMP: _____________________________________________
    DATE:_______________
    ADDRESS:_________________________________________________________
    ___________________________________________________________________
    INSTRUCTION

    College/University Stamp

    Eligibility Criteria:
    o Final Year Student (5th year for local students & 4th year for international students)
    o Minimum placement is for 02 weeks
    o Maximum placement is for 08 weeks
    Please attach the following documents to complete your application:
    o Two recent/current passport size color photographs
    o A form of identification (a copy of your CNIC/Driving License/Passport)
    o Educational Degrees/Latest transcript
    o A letter from the institution confirming your current status as a student.
    Application Fee (non-refundable) to be submitted with the application
    o Domestic applicants: Pakistan Rupees Rs. 1,500 Payment, can be made by cash, bank
    draft or pay order payable to "SHAUKAT KHANUM MEMORIAL TRUST"
    o International applicants: Pounds Sterling 75, or US Dollars $ 150 as a bank
    draft payable to SHAUKAT KHANUM MEMORIAL TRUST"
    Send your completed application to
    EXTERNAL ELECTIVE OFFICE
    SKMCH&RC, 7A, Block R3 Johar Town, Lahore, Pakistan
    Tel: +92 42 35945100 Ext 2524;
    UAN: 111-155 -555
    Fax: +92-42-35945207

    HRD (EEO-SEA 2010)

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