Physician Enhancement Program (PEP) Application

STUDENT INFORMATION

First Name

Middle Name

Family Name

Enter your name as you would like to see it on your certificate which we will present to you at the conclusion of the program:

Important: provide your personal email address below and not an email address shared with other people. Once accepted into the program we will be using email as our primary way to communicate with you so please check it often for updates.

Email Address

Birthdate

Gender

Female

Male

Prefer not to disclose

Prefer to self-describe

Self-describe:

How long would you like to come for the program?

3 months

6 months

12 months

INSTITUTION INFORMATION

Institution Name, Contact Person, Email

Program/Major

Type of Program

5-year

6-year

7-year

8-year

ENGLISH LANGUAGE PROFICIENCY

English Language Proficiency (Check all that apply):

TOEFL

IELTS

None

Other

Please specify

HOW DID YOU HEAR ABOUT US

How did you hear about this program (Check all that apply)?

Please specify

EXPERIENCE

Please describe your overseas study experience(s) if you have any (200 words or less). If you do not have any, go to the next question.

Please list your expectations for this program and explain how the program will benefit your future study (250 words or less).

PROTECTION OF PRIVACY

The personal information requested on this form is collected under the authority of the Alberta Post‑Secondary Learning Act and the Alberta Freedom of Information and Protection of Privacy Act for authorized purposes including admission and registration; administration of student records; consideration for scholarships and awards; and provision of student services. Personal information may be disclosed to academic and administrative units according to University policy; alumni relations and fundraising upon graduation; university planning and research in accordance with federal and provincial legislated reporting requirements; information sharing agreements; and to contracted service providers as required.

For further information on the use and disclosure of personal information, please contact the Physician Enhancement Program at ypp@ualberta.ca.

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Physician Enhancement Program (PEP) Application

Are you logging in to review and/or continue a current application for admission?

Are you a previous or continuing University of Alberta student?

Are you applying to a professional program in the Faculty of Medicine and Dentistry, Faculty of Pharmacy and Pharmaceutical Sciences or the Faculty of Law?

Are you studying or have completed any education in Alberta?

Physician Enhancement Program (PEP) Application

Are you logging in to review and/or continue a current application for admission? YesNo

Are you a previous or continuing University of Alberta student? YesNo

Are you applying to a professional program in the Faculty of Medicine and Dentistry, Faculty of Pharmacy and Pharmaceutical Sciences or the Faculty of Law? YesNo

Are you studying or have completed any education in Alberta? YesNo

Are you logging in to review and/or continue a current application for admission?

Are you a previous or continuing University of Alberta student?

Are you applying to a professional program in the Faculty of Medicine and Dentistry, Faculty of Pharmacy and Pharmaceutical Sciences or the Faculty of Law?

Are you studying or have completed any education in Alberta?