Residency Programs Selection Application Form

Hamad Medical Corporation - Residency Programs Selection Application Form

Please read FAQs before completing the Application Form (Type or Print in CAPITAL LETTERS.)

3. Contacts Details:

Contact Nos. in Qatar (Home): Mobile: Fax:

Address in Qatar:

Contact Nos. in Home Country: Mobile: Fax:

Address in Home Country:

E-mail Address:

In Case of Emergency, person to contact (next of kin)

Name: Mailing Address:

Tel. No. (Home): Mobile: E-mail:

Attachments: (Passport copy, Qatar ID/Residency Permit, 8 photos)

4. Education and Qualifications:

Name of Medical College: Country:

Name of academic degree awarded:

Date of Graduation:

Language used in Medical College: English Arabic Others

5. Internship/House Officer Appointment (First year post graduate training):

Rotating Internship: HMC Other

Straight Internship (1st year post graduate training):

Institution name: Country:

Dates: From: To:

Medical license no: Type: Country: Validity:

6. Post Graduate Training

Dates: From: To:

Institution name: Country:

Describe (clinical training/work):

Other academic qualifications (i.e. Masters, PhD, Others)

Dates: From: To:

Institution name: Country:

Certificates (Fellowship or Board Certifications)

Name: Country: Awarded:

Attachments: (Copy of medical degree certificate, copy of internship certificate, copy of medical license, copy of clinical experience certificate or research, copy of other academic qualification certificates)

7. Current Clinical Post

Position Title:

Institution/Hospital name: Country:

Dates: From: To:

8. Matching choices

Program Choices: (First) (Second)

* ACGME-I Accredited Programs

9. Mandatory Enrollment Exams to HMC Residency Programs:

a. Have you applied for the matching of HMC residency program before? Yes No

If Yes, Date/s: Program/s:

b. How did you learn about the Residency Program at HMC? Internet/Social Media Newspaper Advertisement Friend Staff at HMC

c. Did you apply for the Residency Program from outside Qatar? Yes No

If Yes, pls. specify the country

10. English Language Required Competency Exams:

If not available yet, attached registration copy

11. Please indicate if you have done any the following;

a. Have you previously had a Clinical Attachment at HMC? Yes No

If Yes, pls. specify the program/s and date/s

b. Have you had any publications published or taken part in any scholarly activities previously? Yes No

If Yes, please list the recent

c. Have you attended any courses/workshops previously? Yes No

If Yes, please list the recent

12. Please provide any other information that might support your application:

Attachments: (Copy of USMLE Step 2 CK / IFOM results, copy IELTS/TOEFL results, copy of ECFMG certificate if there is any, recent CV, Letter of Intention, evidence of clinical experience/employment certificates)

Required attachments with the application form

13. Completed Application Form should include the following mandatory documents (1 set of documents)

Please visit Hamad Medical Corporation - www.hmc.org.qa to print the Application Form.

Completed Applications should be delivered in person or by express/registered mail to:

Hamad Medical Corporation,
Medical Education Department,
Al Rayan Street,
P.O.Box 3050
Doha State of Qatar,
Tel. no. 4439-1739/36/43/42
(Email and fax copies are not accepted)