2021-2022 Student Placement Preferences
Please note that clinical experiences may occur across the GTA. Students can expect to have at least a one-hour commute for some placements. The On-Line form will closed on June 28, 2021 at NOON.
Form
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Personal Information
The University of Toronto respects your privacy. The information on this form is collected pursuant to section 2(14) of the University of Toronto Act, 1971. It is collected for the purpose of administering admission, registration, academic programs, university-related student activities, activities of student societies, financial assistance and awards, graduation and university advancement, and for the purpose of statistical reporting to government agencies. Your IP address and browser version are collected for Information Technology troubleshooting, as may be required. At all times, all data is protected in accordance with the Freedom of Information and Protection of Privacy Act. If you have questions, please refer to www.utoronto.ca/privacy OR contact the
University’s Freedom of Information and Protection of Privacy Office at 416 946-5835,
Room 104, McMurrich Bldg.,
12 Queen’s Park Crescent West,
Toronto, ON, M5S 1A8Data Collected
The following Data is collected on this form (* indicates required field)
Student First Name*
Student Last Name*
Student Number*
Student Email*
Enter Email Confirm Email*
Do you have access to a car?*
Yes
No
Do you speak any other languages fluently?
Please provide the languages
0 of 100 max characters
Please provide the major intersection or area of GTA where you will be during the next academic year*
0 of 100 max characters
Areas of Practice you are most interested in: (i.e. Mental Health, Development & Pediatrics, Community Health, Palliative Care, Public Health, Hospital Programs with Vulnerable Populations, Women’s Health).
Practice area #1*
Practice area #2*
Practice area #3*
Additional Information:
To help faculty assign you to the best possible placement, please provide additional information in the box below. Include specific populations that you are interested in working with and/or a disease or health issue that you are interested in learning more about. If there are any particular considerations regarding your placement, please include here. Please be aware that while we attempt to match students with their preferences, this may not always be possible.
Additional information that you would like to share
0 of 100 max characters
Please upload your Clinical Resume*
Please format the name of your resume file as lastname_firstname.
Do you identify as Indigenous and are interested in an Indigenous community placement?
Yes
No
Are you currently employed?
Yes
No
Are you able to provide care in French/English bilingual health care setting?
Yes
No
Other Data Collected
This data is automatically collected by the system for the purpose of Information Technology administration and trouble shooting, as may be required and for summary-level only website statistical reporting:
Browser Type
Browser Version
IP Address (does not identify you)
Hardware and operating system (reported on an aggregate level)
Country/city of origin (reported on an aggregate level)
Session duration (reported on an aggregate level)