Resident & Student - Placement Pre-Approval Form

Yukon Resident & Students

Placement Pre-Approval Form
Any questions can be directed to:

Fund Manager, Yukon Medical Association
5 Hospital Road, Whitehorse, YT Y1A 3H7
funds@yukondoctors.ca
Role

Other
Name

First NameLast Name
Preferred E-mail Address
Your E-mail Address
Preferred Contact Number
Format: (000) 000-0000.
Estimated start date elective booked

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Estimated rotation end date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Any extra info or dates if needed (optional)
Program Requirements:
- apply to the program for reimbursement within three months of the date of completion of the learning period in Yukon;
- acknowledge and disclose all financial assistance received for the same eligible expenses and only apply for reimbursement for expenses not already covered;
- do not submit expenses related to the travel for a spouse, family members or dependents;
- submit a reimbursement claim detailing all travel related expenses including photocopies, flatbed or sheet-fed scans of actual receipts and documents to set up for payment via direct deposit;
- keep their original receipts for income tax purposes and send copies with the reimbursement claim; and
- not apply for reimbursement of expenses for vacation time in the Yukon prior to or after completing a learning period.
Reimbursement from other jurisdictions for the same expenses for the same time period could result in fraud charges.
I certify

Yukon Resident & Students