For Office Use R 18 HMC RESIDENCY MATCHING APPLICATION CHECKLIST Name of Applicant Please Check Candidate GMEO 1. Completed HMC Residency Matching Program Application Form 2. Curriculum Vitae (see FAQs Appendix B) 3. Letter of Intent (for each program applied for) 4. Copy of Medical Degree in English or translated into English 5. Medical School Transcripts in English or translated into English 6. Copy of Internship Certificate in English or translated into English 7. Clinical Knowledge Examination Results (Required) {USMLE Step 2 CK} or {IFOM-CSE} or {MCCEE and MCCQE Part 1) (see FAQs Question 5) 8. English Language Competency Examination Results: {IELTS (Academic)} or {TOEFL (Professional)} (see FAQs Question 5) 9. Additional Clinical Knowledge Examination Results (Optional) {USMLE Step 1, Step 2 CS, Step 3} or {IFOM-BSE} or {MCCQE Part 3) (see FAQs Question 5) 10. Copy of graduate clinical practice/training (if applicable) 11. Recommendation Letters (Dean s Letter, Current Supervisor/Program Director, Other Consultants) 12. Copy of Valid Passport 13. Copy of Residency Permit and QID (if Resident in Qatar) 14. Eight (8) Recent Passport-sized Photos (4 x 4 cm on white background) 15. Any other supporting documents: a. b. I hereby attest that all the documents attached to my application are true copies of the authentic original. Applicant s Signature Date GME Coordinator PLEASE READ THE FAQs BEFORE COMPLETING YOUR APPLICATION
Photo 4x4cm White background only Hamad Medical Corporation Department of Medical Education RESIDENCY PROGRAMS MATCHING APPLICATION FORM Academic Year 2018-2019 Please read the FAQs before completing and submitting the Application Form TYPE/PRINT IN CAPITAL LETTERS Candidate Name (as printed in the Passport) Date of Birth DD ( DD/MM/ / YYYY / ) Place of Birth Nationality Gender Male Female Civil Status Single Married Passport Information Passport Number Expiry Date / / Resident in Qatar? Yes No If Yes, please specify your RP No. Contact Details Home Tel. No. Mobile No. Fax Address In Case of Emergency, Person to Contact (Next of Kin) DD ( DD/MM/ YYYY YYYY ) Name Relationship to Candidate Address Home Tel. No. Mobile No. Fax Education and Qualifications Name of Medical Degree Awarded Name of Medical School Date of Joining the Medical School / DD ( DD/MM/ / MM YYYY YYYY ) Date of Graduation from / DD ( DD/MM/ / YYYY YYYY ) the Medical School (Date of Final Exam) Language Used in Medical College English Arabic Other (Pls. specify) Other Academic Qualifications (i.e. Masters, PhD, Others) Name of the Academic Qualification Awarded who awarded the degree Date of Joining / DD ( DD/MM/ / YYYY YYYY ) Date of Graduation / DD ( DD/MM/ / YYYY YYYY ) the Academic Program from the Academic Program Internship (first year post graduate) HMC Other Institution
Address of Institution DD ( DD/MM/ MM YYYY YYYY Date of Joining / / DD ( DD/MM/ MM YYYY YYYY Date of Graduation / / the Internship Program the Internship Program Medical License Do you currently have a medical license? Yes No Medical License No. Type where license is issued Language License Valid Until DD ( DD/MM/ YYYY YYYY ) Language Spoken Written Fluent Average Below Average Fluent Average Below Average Arabic English Others (Please specify) Exam Results/Scores Clinical Exams English Language Required Competency Exams Exam 3-Digit Score Date No. of Attempts Exam Score Date USMLE Step 1 USMLE Step 2 CK(Clinical Knowledge) * IELTS minimum score: 7.0 USMLE Step 2 CS (Clinical Skills) USMLE Step 3 TOEFL (IBT) minimum score: 80 IFOM CSE * IFOM - BSE TOEFL (CBT) minimum score: 213 MCCEE * MCCQE 1 * MCCQE 2 TOEFL (PBT) minimum score: 550 *Mandatory Requirement: (USMLE Step 2 CK) or (IFOM-CSE) or (MCCEE and MCCQE 1) -Graduate Training or Clinical Practice after completing Internship Training List and provide details on your postgraduate training or clinical practice (professional and hospital positions). List in reverse-chronological order starting from the current clinical post. Current Clinical (The post which you currently hold at the time of completing this application) From / / ( DD/MM/ YYYY ) ( DD/MM/ YYYY )
Other Clinical Training s From / / ( DD DD/MM/ YYYY YYYY ) ( DD/MM/ MM YYYY YYYY ) From / / ( DD/MM/ YYYY ) ( DD/MM/ YYYY YYYY ) Letters of Recommendation Letter From the Dean Letter From the Current Supervisor or Program Director Letter From Other Consultant/s Matching Choices Anesthesiology* Family Medicine* Neurosurgery Orthopedic Surgery* Cardiothoracic Surgery General Surgery* Obstetrics and Gynecology* Pediatrics* Community Medicine Internal Medicine* Otolaryngology* Anatomical Pathology Emergency Medicine* Neurology Ophthalmology* Psychiatry* Dermatology Radiology* Plastic Surgery Urology* *ACGME-I Accredited Programs PROGRAM CHOICE 1 PROGRAM CHOICE 2
Have you previously applied for the HMC Residency Match? Yes No If Yes, Year Applied Program/s Applied To How did you learn about the Residency Programs at HMC? Internet/Social Media Newspaper Advertisement Friend/Colleague Staff at HMC Did you apply for matching in other Residency Programs outside Qatar? Yes No If Yes, please specify the country Is your Spouse working in HMC? Yes No If Yes, please indicate your Spouse s name and the department Is your Spouse applying with you to a Residency Program at HMC? Yes No If Yes, please indicate your Spouse s name and the Program/s Are you currently enrolled into any Sponsorship Program? Yes No If yes, please specify the name of your sponsoring institution and the duration of the sponsorship Have you had any publications or took part in any scholarly activities? Yes No If yes, please specify Do you have any Awards, or Merits during your education and postgraduate training? Yes No If yes, please specify Additional Information Please provide any other information that might support your application: For more information, please visit the Hamad Medical Corporation Official Webpage www.hamad.qa Please do read the Frequently Asked Questions before submitting your applications Complete Applications should be delivered in person or by express courier/registered mail to: Hamad Medical Corporation Medical Education Department Al Rayyan Street, P.O. Box 3050 Doha, State of Qatar Tel. no. 4439-1747/1735/1736/1752 E-mail: postgrad@hamad.qa medicaleducation@hamad.qa (Email and fax copies are NOT accepted)