Fellowship Application CSCC | SCCC E Fellowship Application Instructions on Applying for Fellowship Applicants who are applying under categories 1 & 2 are not required to submit letters of reference. Applicants who are applying under categories 2 - 4 must submit their curriculum vitae and copies of supporting documentation, including diplomas, certificates, and degrees relating to Clinical Chemistry/Biochemistry. Applicants who are applying under category 3 or 4 must apply by November 30 of the year preceding the oral exam. (eg. applications after November 30, 2016 if eligible, would take the oral exam in June 2017) The application must be signed by the applicant. Signature on the application form will be taken as affirmation that the credentials listed are correct. Validation Fees: this once-only fee must accompany the application. For the future, Fellowship fees will be assessed annually and will appear on your annual CSCC Membership Invoice.Requirements 1-3: CDN$ 226 ($200+HST) (non-refundable) Requirement 4: CDN$ 508.50 ($200+HST fellowship fee is non-refundable; $250+HST exam fee is refundable) Only the Board of the Academy can award the Fellowship. Withdrawal: Candidates may withdraw from an exam for personal or family emergencies such as serious medical illness or death of a family member. The consequences for an unjustified withdrawal is a failure in the missed exam Requirements for FellowshipAll applicants for Fellowship must be Full members of the Canadian Society of Clinical Chemists and must meet one of the following requirements: Possess Certification in Clinical Chemistry/Biochemistry as issued by the Canadian Academy of Clinical Biochemistry (CACB)/Canadian Society of Clinical Chemists (CSCC) Possess a Specialist Certificate in Clinical Biochemistry issued by the Ordre des Chemistes du Quebec (OCQ) since 2000 Possess Fellowship in Medical Biochemistry, be a member of the Royal College of Physicians and Surgeons of Canada in good standing, and work in the field of Medical Biochemistry Must have successfully completed a two (or more) year accredited Clinical Chemistry/Biochemistry training program and be a doctoral certified member or Fellow of an approved Foreign Academy of Clinical Chemistry/Biochemistry1 and be successful in the CACB Oral examination2 1 Currently acceptable designations are Diplomate of the American Board of Clinical Chemistry (DABCC) or Fellowship of the Royal College of Pathologists (FRCPath) 2 Applicants who wish to apply under Requirement #4 shall be required to take the CACB Oral examination. Upon passing the Oral examination, they are not deemed to be certified, but are deemed to have met the requirement for Fellowship.Application for FellowshipFellowship Type(Required) Requirement 1 Requirement 2 Requirement 3 Requirement 4 Please upload your CVMax. file size: 100 MB.Name(Required) First Last Certification(Required) Yes No Certification Date MM slash DD slash YYYY Certification by CACB OCQ Other CACB Oral Examination Taken Yes No CACB Oral Exam Date MM slash DD slash YYYY University DegreesPlease attach photocopies of diplomas and certification documentation.YearDisciplineUniversity Add RemoveCertification DocumentsPlease upload copies of diplomas and certification documentation. Drop files here or Select files Max. file size: 100 MB. Academic AppointmentsPositionUniversityEffective Date Add RemoveNumber of Yearsof professional experience in clinical biochemistryDate JoinedFull member of the Canadian Society of Clinical Chemists since MM slash DD slash YYYY Positions HeldSince completion of academic trainingPositionInstitutionInclusive Dates Add RemoveThe Credentials Committee of the Academy requires two (2) letters of reference to support the application. One of these letters must be from your Post-Doctoral Clinical Chemistry/Biochemistry Training Program Director. NOTE: Reference letters are not required for applicants who apply under requirement #1 (who have successfully completed the CACB Oral Examination) and # 2 Reference letters are required to contain comments on the following categories: Ability to function as a clinical biochemist Aptitude to work under challenging and stressful conditions Description of communication skills (written and oral) Problem solving skills Ability for methodology development Other skills of interest in the field of Clinical Biochemistry Please note that all categories must be identified. If the referee is unable to comment on a particular item, if should be noted as “I cannot comment on this item”.Name of Reference #1 First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Enter Email Confirm Email Name of Reference #2 First Last Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country PhoneEmail Enter Email Confirm Email Awknowledgement(Required) I attest that the above statements are true and I hereby apply for Fellowship in the Canadian Academy of Clinical Biochemistry.Address Street Address Address Line 2 City Province Postal Code
