Full Name: Provide your full name as indicated on your proof of Canadian Citizenship or Permanent Residency Card.
ECFMG Number: Write your ECFMG or United States Medical Licensing Examination (USMLE) number in the boxes provided. If you have a United States Medical Licensing Examination (USMLE) number, the Exchange Visitor Sponsorship Program (EVSP)/ Educational Commission for Foreign Medical Graduates (ECFMG) will use that as your numeric identifier. If you do not have a USMLE number, contact the EVSP at evsp-support@ecfmg.org to obtain your number.
Proof of Citizenship: Indicate in the circle provided if you are a Canadian Citizen or Permanent Resident of Canada. Additionally, with your application, submit a certified copy of one of the following documents:
Contact Information: Provide a telephone number and email address where you can be reached. Indicate your permanent address in Canada and the mailing address where you wish to receive a copy of your Statement of Need (if different from permanent address). If mailing address is the same as your permanent address, indicate N/A.
Indicate the name of the University/School of Medicine/Osteopathic Medicine where you have completed (are currently completing) your medical degree, as well as the country and year you graduate.
Indicate any completed postgraduate training in Canada and/or the United States (provide field of medicine, name of university or hospital and year finished or anticipate finishing). If you completed a preliminary year or transitional year, include this information.
Provide the standard wording accepted by the Exchange Visitor Sponsorship Program (EVSP). The EVSP/Educational Commission for Foreign Medical Graduates (ECFMG) requires the exact name of the training program be written on your Statement of Need. For specialties, write down the field of medicine (e.g. Internal Medicine, Family Medicine, Anesthesiology, etc.) For post residency fellowships, write down the specialty and the title of the fellowship (e.g. Anesthesiology - Pain Medicine). For non-standard fellowships, the accepted wording is usually on your letter of offer or contract; however, you should consult your ECFMG Training Program Liaison to verify you write down the accepted title of the training program.
Read and initial each section under Part E of the Application Form. Include the training you intend to practice in (on the line provided) upon return to Canada. If consenting to provincial and territorial government recruitment, include consent form for recruitment. Applicants must initial section E, sign the application form and have a witness' signature.
If you initial consent for disclosure, submit the Consent Form for Recruitment. Print the PDF form located on the Health Canada website. Read both pages of the form first, then initial page one and sign page two with a witness.
Include the following additional documents with your application form:
Submit a certified of one of the following documents (as indicated above in Section A):
Contact one of the following professionals to notarize / certify your proof of citizenship/ residency documents:
The person certifying your document cannot be a family member. Most professionals will prepare the document according to their professional practice. This person must see the original document, make a photocopy of the original document, compare the original document to the photocopy, and print the following on the photocopy: "I certify this to be a true copy of the original document".
This person must also write on the photocopy:
This person must also sign the photocopy. Applicants should not sign anywhere on the photocopy of the document. Once certified, submit the copy in your email application submission. Documents that are unclear or illegible may cause delays in processing of application.
Provide a copy of ONE of the following:
Declaration that the information within the application is accurate and support the applicant's identity and training they wish to pursue.
Witness can be any individual 18 years or older.
Submit all required documents by email to the Program Administrator, Health Canada. Only complete packages can be considered for a Statement of Need. It is the applicants' responsibility to ensure all required documents are submitted. Ensure email is less than 20 megabytes.
Submit your application by email:
Applicants who obtain a Preliminary Year and a residency must apply for a Statement of Need for both at the same time (include both preliminary and categorical application in the same email).