The Confidential Assessment Form, provided by the Ontario Medical School Application Service (OMSAS), serves as an integral component in the application process for individuals aspiring to enter medical universities in Ontario, Canada. This form requires applicants to submit their name and email address and forward the document to a chosen referee who will evaluate them. The referee, typically a figure of professional authority well-acquainted with the applicant, is tasked with rating the candidate across various competencies such as intellectual capacity, initiative, leadership, maturity, and several others that are deemed essential for a future in medicine. These ratings are to be compared against a specified group, enhancing the assessment's relative accuracy. Additionally, the referee provides insights into the applicant’s moral and ethical character, strengths, weaknesses, and overall suitability for the medical profession. Importantly, the form underscores the requirement for these assessments to be delivered directly to OMSAS, keeping them confidential from the applicant. The guidance to use regular postal services for submission, despite possible delays, stresses the form's sensitive nature and the volume of applications processed by OMSAS. Moreover, referees are advised to maintain a copy of their assessment, ensuring a record of their participation in the applicant's medical career journey.
| Question | Answer |
|---|---|
| Form Name | Confidential Assessment Form Omsas |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | omsas caf, r omsas candidat, the confidential formulaire, confidential assessment form |
Return to/Retourner au: |
Confidential Assessment Form |
OMSAS |
Formulaire d’évaluation confidentielle |
Ontario Universities’ Application Centre |
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170 Research Lane |
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Guelph ON N1G 5E2 Canada |
Ontario Medical School Application Service |
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Service ontarien de demande d’admission en médecine |
To The Applicant
1.Your name and email address should be recorded in the space to the right.
2.Forward this form to the referee.
Candidat(e)
1.Votre nom et votre adresse électronique paraissent dans l’espace à droite.
2.Envoyez le formulaire au répondant.
Referee/Répondant
Referee’s Name
Nom du répondant
Position
Position
Department
Département
Address
Adresse
Postal Code |
Area Code & Phone Number |
Code Postal |
Indic. rég. & No de tél. |
Email Address |
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Adresse électronique |
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To the Referee
1.Please check the appropriate rating box for each characteristic that most accurately represents your opinion of the applicant in comparison to a representative group of individuals who have had approximately the same training and experience. Please print legibly in black ink.
2.On your usual stationery, please comment on the applicant’s moral and ethical character; strengths and weaknesses; outstanding characteristics; and your ranking of the applicant from the chart and the questions below. Unfortunately, the medical schools will not be able to give the applicant full consideration without this additional information.
3.Forward this assessment and accompanying letter directly to OMSAS – do not issue to the applicant. The information provided will not be made available to the applicant.
4.OMSAS strongly encourages you to use regular postal services. Due to the volume of mail received by OMSAS, the use of courier services or express mail envelopes physically strains the staff responsible for opening and processing this mail. Please allow enough time to post your Confidential Assessment Form by regular mail. OMSAS strongly suggests that you keep a copy of this reference for your files.
Applicant/Candidat(e)
Name
Nom
Area Code & Phone Number
Indic. rég. & No de tél.
Email Address
Adresse électronique
Répondant
1.Pour chaque caractéristique, veuillez cocher la case d’évaluation appropriée qui correspond le plus exactement à votre opinion du (de la) candidat(e), comparativement à un groupe représentatif ayant sensiblement la même formation et la même expérience. Écrire lisiblement en noir en caractères d’imprimerie.
2.Sur votre papier à
3.Veuillez envoyer cette évaluation et toute lettre à l’appui directement au OMSAS. Veuillez ne rien remettre au candidat. Les données qui y figurent ne seront pas transmises au (à la) candidat(e).
4.OMSAS vous incite fortement à utiliser le service postal régulier. Étant donné le volume de courrier que reçoit OMSAS, l’utilisation de services de messagerie ou de courrier exprès exerce une pression indue sur le personnel responsable du traitement de la correspondance reçue par la voie de tels services. Veuillez prévoir suffisamment de temps pour acheminer votre formulaire confidentiel d’évaluation par la poste régulière. OMSAS vous incite fortement à conserver une copie du présent formulaire dans vos dossiers.
Please indicate the size of the group you are using for comparison, if applicable: ____________ |
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Veuillez indiquer l’étendue du groupe que vous utilisez pour la comparaison, s’il y a lieu : |
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(e.g., Group of 50, 100) |
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Appropriate Rating |
Top 5% |
Top 10% |
Top 20% |
50% |
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Below 50% |
Unable to Judge |
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Cote appropriée |
Percentile 5% |
Percentile 10% |
Percentile 20% |
Moyen |
Moins de 50% |
Évaluation impossible |
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Intellectual Capacity |
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Aptitude intellectuelle |
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Initiative |
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Initiative |
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Leadership Capabilities |
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Qualités de chef |
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Maturity |
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Maturité |
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Cooperation |
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Coopération |
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Integrity |
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Probité |
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Problem Solving |
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Résolution de problèmes |
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Fluency in Spoken English |
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Compétence en anglais parlé |
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Fluency in Written English |
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Compétence en anglais écrit |
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Ability to Communicate |
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Aptitude à communiquer |
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Ability to Relate to Others |
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Entregent |
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Ability for |
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Aptitude à apprendre par |
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Critical Thinking Ability |
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Aptitude à la pensée critique |
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Overall Rating
Cote globale
I have known the applicant for |
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(e.g., six months) |
Je connais la candidate ou le candidat depuis |
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(p. ex., six mois) |
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in the capacity of |
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(e.g., Supervisor). |
en tant que |
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(p. ex., Superviseur). |
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Is the applicant the type of person who would make a good physician in your community? |
Le candidat ou la candidate |
|||||||
Yes
No
Oui
Non
Referee’s Signature |
|
Date |
Signature du répondant |
|
Date |
Please return this assessment and accompanying letter by October 1, 2012.
OMSAS will acknowledge receipt of this form.
Veuillez retourner cette évaluation et toute lettre à l’appui avant le 1 octobre 2012.
OMSAS accusera réception du formulaire.