Medical Council of Canada

W. Dale Dauphinee Fellowship Application Form

W. Dale Dauphinee Fellowship Application Form

Contact information and application details

Personal information provided in your application will be used solely for the purpose of adjudication and treated in accordance with the Medical Council of Canada Privacy Policy.

  • Please indicate: Street Address, Apt./Floor; City; Province; Postal Code; Country
  • Please specify universities and years of graduation. For MDs, please indicate specialties and LMCC number.
  • Must confirm protected time and reason.
  • (1) The reason this Fellowship will be of particular value to you; (2) The nature and purpose of your proposed study/innovation; (3) Plan for dissemination of skills and knowledge gained within a broader Canadian context; (4) Future plans including specific learning objectives and tasks.
  • (1) Grants; (2) Awards; (3) Publications/technical reports.


Should you have any questions about the W. Dale Dauphinee Fellowship, please do not hesitate to contact us via