Training Verification Online Payment Form (discontinued 20240306)

Training Verification Online Payment Form

Please read the instructions below carefully prior to completing the accompanying form.
INSTRUCTIONS

Before sending payments, please send all inquiries and requests to trainingverification.medicine@utoronto.ca. The Training Verification Officer will first confirm the trainee was in fact with the Department of Medicine, University of Toronto, and will then determine the verification needed and costs associated with the requests.

Training verifications will not be processed until payment has been received and consent to release information has been signed by the trainee and received by the Department of Medicine.

Important Notes:
- Processing Time: Upon retrieval, training verifications will be finalized within 10 business days of receiving payment and consent.
- Refund Policy: In the event we are unable to complete the verification of training, the full refund will be issued as a cheque that will be mailed out, which may take up to 6-8 weeks. Otherwise, all payments are final and no refund will be issued.
For detailed information, please refer to the Department of Medicine Training Verification.
Requesting Institution/Person’s Contact Information

Please provide the following information about the requesting institution/person.
Requestor's Name*

First NameLast Name
Requestor's Email*
example@example.com
Company Name Requesting Verification (if applicable)
Physician's Personal Information

Please provide the following information about the person whose credentials are being verified.
Physician's Name*

First NameLast Name
YesNo
Form confirming training years only (No fee)Forms requiring assessments of training and/or evaluating standing ($150.00 CAD)Letter confirming training years only ($150.00 CAD)Letter confirming assessments of training and/or evaluating standing ($250.00 CAD)
Form confirming training years only ($150.00 CAD)Forms requiring assessments of training and/or evaluating standing ($250.00 CAD)Letter confirming training years only ($250.00 CAD)Letter confirming assessments of training and/or evaluating standing ($450.00 CAD)
Priority mail within Canada ($30.00 CAD)Priority mail to the United States ($50.00 CAD)Priority mail to international destination ($100.00 CAD)Verification via email
Shipping Mailing Address Information
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Online Payment Information
Total amount of payment will be (Canadian dollars):
YesNo
Company Name (if applicable)
Billing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Online Payment Information

CADTotal amount of payment (Canadian dollars)

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

The Department of Medicine has partnered with Moneris (service provider) to provide clients with an online credit card fee payment option.

The online Mastercard and Visa Canadian Dollar verification fee payment service is inclusive of a convenience fee collected directly by Moneris.
Freedom of Information and Protection of Privacy: The University of Toronto is committed to the protection of privacy. Ontario universities are covered by the Freedom of Information and Protection of Privacy Act (the Act) which supports access to University records and protection of privacy. The University upholds these principles. For detailed information and its application, please visit https://www.utoronto.ca/privacy.
Should be Empty:

Training Verification Online Payment Form

Requesting Institution/Person’s Contact Information

Physician's Personal Information

Shipping Mailing Address Information

Online Payment Information