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Faculty of Medicine
For new account (sponsored, stipend) or change in role - UGME
Please select status
Hospital Coordinator
Rotation Director or Co-Director
Other…
For Other, please explain :
Title
Surname
Given Name
Middle Name
Gender
Male
Female
Other
Language of Correspondence
French
English
Office Address
Building/Room #
Street
City
Province
Postal Code
Home Address
Building/Room #
Street
City
Province
Postal Code
Alternate Email Address (to send new user information)
Business telephone number
Rotation Name
Stream
Anglophone
Francophone
Department
Contract Start Date
Contract End Date
Date of birth (required for sponsored account)
University of Ottawa Employee number or student number (if available), uOttawa username is acceptable
Requested Access
One45
Elentra
Brightspace
MTD Portal
Stipend Databse
Curriculum Drive "W"
Questionmark
Student Record
E-Portfolio
Additional Information
New position or *Replacement for
*Upon processing of this request the replacement HC/RD will be granted system access and permissions, while former HC/RD access and permissions will be terminated, unless otherwise specified
Effective Date
Comments
Electronic Signature of Requestor
Sign above
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