Registration Form – NCIME Scholars Portal

Do you self-identify as Indigenous? *YesNo

If yes, check all that may apply.First NationsMétisInuk

Please specify which Nation or community you are part of.

First Name *

Last Name *

Email *

Phone

Please enter your current place of employment or department(s):

What is your area(s) of study or specialty(ies)? *

What area(s) of medical education are currently working on and/or interested in (Check all that apply) *Admissions and TransitionsLearner RetentionAssessmentIndigenous Faculty Human ResourcesCurriculum DevelopmentAnti-RacismIndigenous MedicineLeadership/MentorshipInterprofessional Indigenous Health Professional Collaboration

The NCIME Medical Education Database. The NCIME understands the importance of Indigenous sovereignty and Data Privacy. We respect your right to control how your information is stored and used. Please carefully read the following consent statements. *I consent to The NCIME to store my information in the NCIME Medical Education Database for NCIME use only.I consent to have my information (Name, position, email) available to NCIME Medical Education Database Users.I consent to have my information shared on a conditional basis with external organizations engaged in Indigenous medical education.