Paediatric Simulation Experience Application - The Hospital for Sick Children

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To apply for a paediatric simulation learning experience, you are required to complete the online application form in Section A. In addition, you are required to upload the following in Section B:

Your current resume/CV
Two letters of recommendation from your supervisors
A letter of intent

Once you submit your online application, you will be provided with a secure link to complete a non-refundable application fee payment of $200 CAD. Please note that completing this application form does not guarantee acceptance.

Following acceptance, you will be contacted to submit additional documentation by email including, but not limited to:

- Immunization record form
- Observation experience agreement
- Certificate of registration
- Copy of your degree
- Proof of health/travel insurance policy

Paediatric Simulation Experience Application

Section A: Online Application

Personal Information

Title

First Name *

Last Name *

Position/Professional Designation *

Area of practice *

Degree and Qualifications (please list) *

Address (Street Address, City, Postal Code, & Country) *

Telephone Number *

Business Phone Number *

E-mail Address *

Emergency Contact Name *

Relationship to You *

Emergency Contact Email Address

Emergency Contact Telephone Number *

Organization Information

Agency/Hospital/Institution Name *

Agency/Hospital/Institution Address (Street Address, City, Postal Code, & Country) *

Supervisor Name *

Supervisor Telephone Number *

Supervisor Email Address *

Contact Information In Toronto

Accomodation Address in Toronto (if known)

Contact Number in Toronto

Learning Experience Information

Expected Start Date (dd/mm/yyyy) *

Which Paediatric Simulation Program are you interested in? *

LITE Certificate in Paediatric Simulation (minimum of 3 months)

LITE Fellowship in Paediatric Simulation (minimum of 12 months)

Why do you wish to visit the Hospital for Sick Children? *

What are your learning objectives? *

What prior learning/experience have you had in relation to these objectives? *

Section B: Supporting

Current Resume/CV*

Please attach your most recent resume/CV

Attach File *

Maximum file size: 516MB

Recommendation Letters (Total of 2 Letters)*

Please attach 2 recommendation letters from your supervisors

Attach File *

Maximum file size: 516MB

Letter of Intent*

Please attach your letter of intent

Attach File *

Maximum file size: 516MB

A non-refundable application fee of $200 CAD will be applied. Upon successful submission of your application, you will be provided with a secure link to complete the application fee payment.

Please allow 4-6 weeks for your application to be processed. You will be contacted by SickKids regarding the status of your application and the fees associated with your learning experience.

Successful applicants will be contacted to provide further documentation, including completed immunization record form, completed experience agreement, certificate of registration (if applicable to your profession), and a copy of your degree (officially translated in English).

It is understood that during your experience you may have access to confidential information. Checking the box below indicates that you recognize that you are in a position of trust with The Hospital for Sick Children and agree to maintain confidentiality at all times.

Checkboxes *

I have read and reviewed the Terms and Conditions*

* Fields marked with an asterisk are required.

Healthier Children. A Better World.^TM

Paediatric Simulation Experience ApplicationInternational Learner Program

Personal Information

Organization Information

Contact Information In Toronto

Learning Experience Information

Current Resume/CV*

Recommendation Letters (Total of 2 Letters)*

Letter of Intent*

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