Referee-Form-201011 by ashrafp

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									                                                                                   Faculty of Medicine

                        This form along with the supporting letter
                             are due on or before January 5, 2011

                   FACULTY OF MEDICINE – DALHOUSIE UNIVERSITY
                         CONFIDENTIAL REFEREE LETTER

                                   To be returned by the referee to
    ADMISSIONS and STUDENT AFFAIRS, ROOM C-124, FIRST FLOOR, CLINICAL RESEARCH CENTER
                   5849 UNIVERSITY AVENUE, HALIFAX, NOVA SCOTIA B3H 4H7
                                              OR
                                     Fax to: 902-494-6369

REFEREE’S NAME AND ADDRESS)                          APPLICANT'S NAME AND ADDRESS
(Please Print)                                       (Please Print)
(please include an E-mail address if possible)


________________________________________________   __________________________________________________

________________________________________________   __________________________________________________

________________________________________________   __________________________________________________

________________________________________________   __________________________________________________

________________________________________________   __________________________________________________


THE APPLICANT NAMED ABOVE, WHO IS APPLYING FOR ADMISSION TO DALHOUSIE
MEDICAL SCHOOL, HAS GIVEN YOUR NAME AS A REFEREE. Since the number of qualified
applicants to the medical school far exceeds the number of positions available, we are anxious
to select those individuals whose accomplishments, personal attributes and abilities indicate
that they have the greatest potential for medical training and practice.

NOTE: If you do not know the candidate well enough to make a valid or detailed
assessment, or if your primary association is as a friend or family friend, it would be in
the interests of both the candidate and the Admissions Committee for you to decline the
invitation to act as a referee.

IN WHAT CAPACITY HAVE YOU BEEN ASSOCIATED WITH THE APPLICANT? (e.g.
instructing, academic advising, socially, friend, employer or supervisor, etc.)




HOW LONG HAVE YOU KNOWN THE APPLICANT?



       Admissions & Student Affairs · Rm C-132, 5849 University Avenue · Halifax Nova Scotia B3H 4H7
 Tel (902) 494-1874 · Fax (902) 494-6369 · medicine.admissions@dal.ca · http://admissions.medicine.dal.ca

								
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