Global Health Elective Application for Residents

Please complete this application, with attachments, at least 4 weeks prior to departure. Please contact or 1.902.494.1965 if you have any questions. Once you complete this application form, one copy will be sent directly to the Global Health Office. Be aware that the process of arranging an international elective may take considerably more time than that of arranging an elective within Canada.

This information will help to ensure that your elective is approved and to determine what assistance, if any, may be required in finalizing your elective.

Name, relationship, contact information including phone and email


Personal Information

(GHO, NGO, University, Hospital)

Please note that you can submit the learning objectives required by your Department in the appropriate CANEMDS framework, if you need advice on formulating objectives for an international elective, please contact the Global Health Office at



Safety Considerations

Including risk rating from the Canadian Consular Affairs Bureau
Exact address must be provided before departure
Please note that proper licensure and malpractice coverage suitable to the country of your proposed elective must be arranged as Canadian licenses and CMPA do not extend outside Canada


Supervisor/Departmental Contact

The requirements for supervision for your elective may vary, depending on the requirements of your Department. Please check with your post graduate director to ensure that you have the appropriate supervision. Please provide information on who the contact is in your Department for your elective.


Applications are not complete until the following are received:

  1. Completion of the Global Health Checklist
  2. Confirmation you have read the Policy for guidelines on HIV Prevention
  3. Confirmation on your registration with ROCA, if applicable

Other resources are available on the International Elective Planning Checklist for Residents.