Mccee Student Attestation Form – Fill Out and Use This PDF

MCCEE STUDENT ATTESTATION FORM

This form is to be completed for an INTERNATIONAL MEDICAL STUDENT or a US SCHOOL OF OSTEOPATHIC MEDICINE STUDENT applying to the Medical Council of Canada Evaluating Examination (MCCEE).

•This form must be completed by the DEAN or REGISTRAR.

•The Dean or Registrar must conirm that the student is within twenty (20) months of completing all requirements to graduate.

•The original completed and signed form must be submitted to the MCC - a photocopy of the completed form will not be accepted.

PLEASE PRINT CLEARLY

THIS IS TO CERTIFY THAT

Student’s Given Name(s)

Surname

is a medical student in good standing and within twenty (20) months of completing all requirements to graduate from the medical school program

at

Name of Medical SchoolName of University

in

City

Country

The above-named student is fully expected to graduate and successfully complete all requirements to receive his/her inal medical diploma on the date(s) indicated below.

The expected date of completion

of all requirements for the medical degree is:

year

month

day

The expected date of awarding of the diploma is:

year

month

day

Certiied by:

Signature of Dean or Registrar

Name of Dean or Registrar

Title:

Date: year

month

day

University seal or stamp

MCC | Student Attestation MCCEE