Standardized Patient Form Dashboard
| 1. Are you completing this form for yourself or on behalf of a minor child | 2. If you are completing this on behalf of a minor child, what is your name, email and relationship to the child. | First | Last | 4. Number | 5. Date Of Birth (day / month / year ) | 6. What are your preferred pronouns? | 7. Phone number | 8. Email address | 9. Current Home Address | 10. Where you previously employed by the University of PEI ? | 11. The majority of Standardized Patient (SP) work takes place from Monday-Friday between the hours of 0800-1700. When are you most available? | 12. Are there certain times of the year when you would not be available? | 13. If you answered "yes", please describe | 14. What is your current employment status? | 15. Are you currently attending college or university? | 16. What is your area of study? | 17. Will you be applying to medical school in the next 12 months? | 18. Are you legally entitled to work in Canada?. | 19. Have you ever been discharged from work because your work or conduct was unsatisfactory? | Professional background | SP Information session | Would you be interested in becoming a teaching patient as well as an SP? | 23. In a few words, what is nature of your medical condition? | REFERENCES |
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| 1. Are you completing this form for yourself or on behalf of a minor child | 2. If you are completing this on behalf of a minor child, what is your name, email and relationship to the child. | First | Last | 4. Number | 5. Date Of Birth (day / month / year ) | 6. What are your preferred pronouns? | 7. Phone number | 8. Email address | 9. Current Home Address | 10. Where you previously employed by the University of PEI ? | 11. The majority of Standardized Patient (SP) work takes place from Monday-Friday between the hours of 0800-1700. When are you most available? | 12. Are there certain times of the year when you would not be available? | 13. If you answered "yes", please describe | 14. What is your current employment status? | 15. Are you currently attending college or university? | 16. What is your area of study? | 17. Will you be applying to medical school in the next 12 months? | 18. Are you legally entitled to work in Canada?. | 19. Have you ever been discharged from work because your work or conduct was unsatisfactory? | Professional background | SP Information session | Would you be interested in becoming a teaching patient as well as an SP? | 23. In a few words, what is nature of your medical condition? | REFERENCES |