Stage 1 Application form for 2024 Cambridge Elective Placements for partnership students 1Introduction2General Information3Medical Education4Elective Preferences5Documentation6Submit This is Stage 1 of the application process for a 2024 Cambridge Elective Placement. Data collected will only be used in relation to your application and complies with Cambridge University's data protection policy. Please see School of Clinical Medicine - How we process your data. Before proceeding with your application please make sure that you are familiar with the Application Stages. During Stage 1 of the application you will be asked to upload the following documents (which must be scanned originals). We would recommend that you have this information ready before you proceed as you cannot save your application and return to it at a later time. Medical Transcript A scanned original of your University Transcript on headed paper, and that has been stamped with the official stamp of your University. This must be your complete Academic Transcript. We are unable to accept any alternative documentation such as results statements. Reference from the Dean of your Medical School A scanned original that has been signed by the Dean, or another appropriate member of senior staff, from your University and has been stamped with the official stamp of your University. If you are from a non-majority English speaking country and hoping to use this letter as proof of English proficiency, please make sure that it clearly specifies that your course has been taught and assessed entirely in English. I have read and understand the above information.* I agree I confirm that I have read and meet the entry requirements.* I agree Name* First Last Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman 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 Email* Enter Email Confirm Email Phone*Gender*MaleFemaleNon binaryPrefer not to sayDate of Birth* DD slash MM slash YYYY Please list ALL of your nationalities in the box below*We request all nationalities to determine if you will require a visa.If you are travelling from a country outside of the UK & Ireland, you will require a visitor visa. We would recommend that you visit the following websites for further information about visas. GOV.UK Website University International Student Team Name of Medical School* Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman 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 Expected Date of Graduation* DD slash MM slash YYYY Please note that the date you input here must coincide with the one on your reference letter. In order to complete your application we require the following documentation to be uploaded. The requested documentation must meet the entry requirements. Any applicants who do not meet these requirements will not be considered for a Cambridge Elective Placement. Please note that we require scanned originals of all documents. Medical TranscriptPlease note that we are only able to accept a scanned original of your full University Transcript/Academic record. The Transcript must be stamped with your University's official stamp. Click here to upload a copy of your Medical Transcript*Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.Reference from the Dean of your UniversityWe request this information to ensure that you possess the right skills to undertake a Cambridge Elective Placement, and have the support of the Dean of your University. The reference letter must be on headed paper, stamped with the official stamp of your University and signed by the Dean or another appropriate member of senior staff. If you aim to use this document as proof of English proficiency, please ensure that it clearly states that your course has been taught and assessed entirely in English.The following information must be included in the reference letter: Assessment of Character & Conduct Assessment of academic ability Knowledge of English Language - written and spoken Confirmation of their support of your application Confirmation that you will be within your final 18 months of study at the time of the elective placement Expected date of graduation (month/year) Click here to upload your University reference letter*Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB.English language certificateWe request this information to ensure that you possess the required level of English to undertake a Cambridge Elective Placement and communicate with patients and staff. The language certificate you upload must be less than 2 year old from the start of your placement. NOTE 1: If you possess a passport from an English-speaking country (eg: Australia, UK, an English province in Canada), you are exempt from providing a certificate and would need to attach a coloured copy of your passport instead NOTE 2: If you completed a qualification equivalent to at least a UK Bachelor's in an English-speaking country within 30 months prior to your elective start date, you may wish to attach a copy of that qualification instead. NOTE 3: If you are studying in a non-majority English speaking country but that your entire course has been taught and assed in English, you may wish to provide a letter from your Dean clearly stating this instead. In this case you will not be required to provide a language certificate. Please ensure that the letter states that you are both taught and assessed entirely in English. NOTE 4: If your home country from List B* but your course is not taught and assessed in English, you will need to provide a copy of your passport and take our in-house language assessment, current fee £93. *List B contains the following countries: Botswana, Ghana, India, Kenya, Mauritius, the Netherlands, Nigeria, South Africa, Sri Lanka, Singapore, Sudan, Swaziland, Uganda, West Indies (with the exception of those in list A), Zambia, Zimbabwe.Click here to upload your proof of English proficiency* Drop files here or Select files Accepted file types: jpg, gif, png, pdf, Max. file size: 8 MB. If there is any additional information that you would like to include with your application please use the box below.Student Declaration I confirm that all of the information provided in this application is true and correct to the best of my knowledge.Please tick the box below to agree to the above statement.* I agree What happens Next? If your Stage 1 application is successful you will be contacted by email and asked to complete Stage 2 of the application process. If, within the application window being open, you need to amend your application, please send an email to cambridge.electives@medschl.cam.ac.uk with the subject line 'amendment to application - ID - full name' and explain the amendments needed. As part of this process you will be asked to provide the following by the specified date which is usually one month after receiving your Stage 2 email: A certified colour copy of your passport An original colour copy of your CRB/DBS/Police check Provide immunisation records and health assessment form to the Occupational Health team VISA information if you are travelling from outside the UK/Ireland For more information about the application process please visit the Application Stages page on our website. If you are happy with your application please click the submit button below. CAPTCHAUnique Submission ID Δ