STUDENT REQUEST FORM
(Turn-around time is 5 business days. Your signature is Mandatory)
Transcripts & diploma translations: Please go to the Registrar on Main Campus.
Immunization Status Sheets:
Please go to Student Health Services at the Brown Bldg.
Quebec Loans & Bursaries:
Please go to Student Aid Office
Dean’s Letter of Recommendation Please visit www.medicine.mcgill.ca/UGME/studentservices/deansletter_en.htm
Verification of Undergraduate Medical Education Please visit www.medicine.mcgill.ca /UGME/student services/credentialing_en.htm
Please check one of the names below: (Staff Email addresses on the reverse of this sheet)
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Danielle Moronval-McDonald (Appointments with Associate Dean, Letters - good standing, full time student, bank loans, credits
attestation, Scholarship, letter of reference, Graduates’ Dean’s Letters other)
Student Record Coordinator or Silvana DiLollo (Student Records, Prizes, USMLE, MCC Application)
Sunita Mathew (Clinical Education - ICM, BCLS, ACLS)
Nicole Guedon (Clinical Education - Core & Senior Clerkships)
Elizabeth Lefebvre (Career Counseling/Residency, Electives, French Workshop, Personal Statements/CVs, Scholarship
References, Appointments with Director of Student Affairs)
Heidi Cheung (McGill Electives, LMCC applications, Graduates’ Credentialing/Licensure Forms, Commissioner of Oaths – for
M.D. undergraduates only)
Mary Cecere (Visiting Students Electives, Graduates’ Credentialing/Licensure Forms.
Commissioner of Oaths – for M.D. undergraduates only)
Anne Briggs (Physicianship & Physician Apprenticeship year 1 to 4, Medicine & Society, Core & elective topics, Communication
Plus, Professionalism, Public Health, Immunization)
Anna Lee (Fundamentals of Medicine & Dentistry, Basis of Medicine, notes & exam info, USMLE Applications)
Kalina Klimp, Tim Johns (Web Editor – MyCourses/D2L)
Please indicate the nature of your request:
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Elective application form to be signed (attach to this sheet) (Elective dates:____________ to _______________)
Elective letter of recommendation/support (includes info. on malpractice insurance coverage, academic standing,
curriculum description, which courses completed)
USMLE application form
LMCC application form
Letter of (a) good standing, (b) full time student, (c) credits attestation (d) scholarship (e) Other
Other/Special Instructions: ________________________________________________________________
Provide complete name and address (not YOUR address) of the institution/office to whom the letter should be addressed (All
requests for letters must identify the purpose for which the letter is required. No letter will be issued unless this information is
provided)
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Print Your Name
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Class of:
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Signature Mandatory
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Telephone/Cell Number
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Today’s Date
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McGill Email Address
NOTE:
ID#
All letters and applications must be picked up from the Reception Area. The Faculty cannot fax, mail or courier out
documents (except for Dean’s Letters and Credentialing) on your behalf. If you are out of town, please arrange to have a
friend pick up your documents or ask us to leave in clear box outside of Dean’s office.
UGME STAFF CONTACT LIST
Robert Primavesi, MDCM, FCFP (EM)
Associate Dean, Medical Education & Student Affairs
E-mail: adugme.med@mcgill.ca
Phone: 514-398-3519
Namta Gupta, M.D.
Assistant Dean, for the Office of Student Affairs
E-mail: namta.gupta@mcgill.ca
Phone: 514-398-5557
Anne Briggs
Curriculum Administrator, Physicianship and Physician Apprenticeship (Years 1 to 4) & Immunization
E-mail: adminphysicianship.med@mcgill.ca;
Phone: 514-398-3781
Mary Cecere
Administrative Coordinator, Electives (Non McGill students) & Credentials
E-mail: electives.med@mcgill.ca;
Phone: 514-398-5390
Silvana Di Lollo
Administrative Officer, Student Records / Student Affairs
E-mail: silvana.dilollo@mcgill.ca;
Phone: 514-398-3518
Farhad Saboohi
Student Records Coordinator
E-mail: studentrecords.med@mcgill.ca;
Phone: 514-398-8045
Anna Lee
Administrative Coordinator, FMD, BOM Units & Examinations, USMLE
E-mail: basis.med@mcgill.ca; fmd.med@mcgill.ca
Phone: 514-398-8358
Elizabeth Lefebvre
Career Advisor
E-mail: careeradvisor.med@mcgill.ca;
Phone: 514-398-5557
Sunita Mathew
Curriculum Administrator, Clinical Education (ICM, BCLS)
E-mail: icmadmin.med@mcgill.ca;
Phone: 514-398-6785
Nicole Guedon
Curriculum Administrator, Clinical Education (Core & Senior Clerkship, ACLS, Topics in Medical Science Seminars)
E-mail: clinicaladmin.med@mcgill.ca;
Phone: 514-398-3516
Danielle Moronval
Student Affairs Coordinator (Secretary to the Associate Dean & Clinical Administrators)
E-mail: studentaffairs.med@mcgill.ca;
Phone: 514-398-3519
Heidi Cheung
Coordinator, Electives (McGill students) & Credentials
E-mail: mcgillelectives.med@mcgill.ca;
Phone: 514-398-3520
Kalina Klimp, Tim Johns
Curriculum Editors (Electronic Medicine Curriculum website - WebCT)
E-mail: e-curriculum.med@mcgill.ca;
Phone: 514-398-1214