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CA MCCEE STUDENT ATTESTATION FORM This form is to be completed for an INTERNATIONAL MEDICAL STUDENT or a US SCHOOL OF OSTEOPATHIC MEDICINE STUDENT applying to the Medical Council of Canada Evaluating Examination MCCEE. The expected date of completion of all requirements for the medical degree is year Certified by Signature of Dean or Registrar month day Name of Dean or Registrar Title Date University seal or stamp MCC Student Attestation MCCEE. ADDRESS MEDICAL COUNCIL OF CANADA CONTACT LE CONSEIL M DICAL DU CANADA 1021 Thomas Spratt Place O ttawa ON CANADA K1G 5L5 Tel 613-520-2240 Fax 613-248-5234 Email service mcc*ca MCC. The Dean or Registrar must confirm that the student is within twenty 20 months of completing all requirements to graduate. The original completed and signed form must be submitted to the MCC a photocopy of the completed form will not be accepted* PLEASE PRINT CLEARLY THIS IS TO CERTIFY THAT Student s Given Name s Surname is a medical student in good standing and within twenty 20 months of completing all requirements to graduate from the medical school program at in Name of Medical School Name of University City Country The above-named student is fully expected to graduate and successfully complete all requirements to receive his/her final medical diploma on the date s indicated below. The Dean or Registrar must confirm that the student is within twenty 20 months of completing all requirements to graduate. The original completed and signed form must be submitted to the MCC a photocopy of the completed form will not be accepted* PLEASE PRINT CLEARLY THIS IS TO CERTIFY THAT Student s Given Name s Surname is a medical student in good standing and within twenty 20 months of completing all requirements to graduate from the medical school program at in Name of Medical School Name of University City Country The above-named student is fully expected to graduate and successfully complete all requirements to receive his/her final medical diploma on the date s indicated below.

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