Not all documents are required for all programs. Applicants can find out which documents they need to include by consulting provincial criteria and individual program descriptions.

Reference materials

References are provided by physicians, professors or non-clinical individuals (also known as referees) recommending the applicant for further medical training.

When an applicant requests a reference through CaRMS Online, the referee is notified of the request. The referee create and upload the reference directly in CaRMS Online. Applicants may request a generic, discipline-specific or program-specific reference.

For step-by-step instructions on how to request a reference in CaRMS Online for applicants, visit our Help Centre.

There are three types of references for this match:

Letter of reference: This type of reference document is a detailed letter that describes a referee’s experiences with an applicant and recommends the applicant for further medical training.

Applicant support form: This type of reference document can be requested if an applicant is applying to a program that requires it as part of their application. It is the applicant’s responsibility to provide a copy of the form, as it is not provided by CaRMS. These forms can be found in the program descriptions of programs requiring them.

Structured reference letters: This type of reference document can be requested by programs if an applicant is applying to one of the disciplines below. They are completed inline by reference providers, which means applicants must pick this option from the drop-down menu in their CaRMS Online account when requesting a reference for these disciplines specifically. You can see samples of these documents below.

International medical graduates

If you are an international medical school, your students may already have reference materials that they have acquired and wish to use in the match. If you wish to submit reference letters on their behalf, please contact for further instructions. CaRMS does not accept hardcopy or mailed documents.

Please note that if the reference is in a language other than English or French, students must provide an official translation. Please do not submit the original foreign language document to CaRMS.

Reference letter guidelines

In order to ensure program directors receive the information they need to evaluate applicants, we recommend letters of reference include:

  • The date the letter was written
  • The time and duration of the referee’s contact with the applicant
  • Assessment of the applicants:
    • Cognitive skills and knowledge
    • Problem solving and patient management skills
    • Behaviour and attitudinal skills
    • Communication skills and working relationships
    • Motivation and punctuality
    • Sense of responsibility
    • Procedural skills specific to the discipline
    • Special qualities and unique contributions

If referees are unable to comment on a specific component of an applicant’s performance in any of the above categories, they should indicate that they have not observed or do not have knowledge of that specific component in their letter.

Early reference request

When CaRMS Online is closed, applicants can contact their referee(s) and request a reference, by completing the early reference form and providing it to their referee. The early reference form must be attached to the reference document when it is sent by referees to CaRMS. Referees must email the early reference form and reference document to Once we receive the early reference form and reference document, we will email applicants to let them know they have been received.

When CaRMS Online opens, applicants must create reference requests for any early letters of reference. Applicants should notify the CaRMS Document Centre at when a reference request has been created and include the reference request ID number so that the early letter of reference can be uploaded to their account. The CaRMS documents team will match the request with the document and upload it to the applicant’s CaRMS Online account. It is the applicant’s responsibility to track which documents have been uploaded. If no request has been created, we will contact the applicant via email.

Note that we cannot upload an early reference document to an applicant’s profile unless they inform us that they have created a reference request.

Examinations and assessments

CaRMS receives select exam results and documentation directly from the source. This simplifies the process and guarantees the validity of the document and results.

The most common examination/assessment results we receive are:

  • Medical Council of Canada’s Evaluating Examination (MCCEE) and Qualifying Examinations (MCCQE I and MCCQE II)
  • National Assessment Collaboration (NAC) examination
  • United States Medical Licensing Examination (USMLE)
  • University of British Columbia’s Clinical Assessment Program (CAP)
  • Computer-Based Assessment for Sampling Personal Characteristics (CASPer)

All results can be sent directly from the issuing organization or uploaded to CaRMS Online by the applicant.

For information on how to submit examination results, consult the document submission instructions.

International medical graduates and Osteopaths

Applicants will be required to provide Medical Council of Canada (MCC) and/or National Assessment Collaboration (NAC) examination results as part of their application. MCC examination data and documents, including the NAC, are only accepted through transfers from* on CaRMS Online. Click here to learn how applicants can connect to the custom sharing page from their CaRMS Online account.

*Note: Results prior to 2006 cannot be sent via If an applicant wrote the MCCEE prior to 2006, they should contact the MCC directly to arrange for a certified copy to be sent to CaRMS.

Language examinations

If a student’s language of instruction during medical school was not English or French, they may be required to submit a language assessment exam according to the provincial eligibility requirements or program descriptions.

Exam expiration dates

Programs require that all submitted documents are valid – meaning that they have not expired. Students are responsible for ensuring that their examination results are currently valid.

Canadian citizenship documents

CaRMS has partnered with third-party organizations to automate the verification of citizenship/legal status required by postgraduate offices for entry into residency. Third-party verification simplifies the process for applicants and programs. All applicants who do not receive third-party citizenship verification will be required to upload and assign an acceptable proof of citizenship document. Please see additional information here.

Many citizenship documents have an expiration date. Applicants should ensure that any citizenship document(s) they submit are currently valid, as expired documents will not be accepted by postgraduate offices.

Applicants may upload multiple document types as proof of Canadian citizenship status. Acceptable citizenship documents vary by province, so they should carefully review the provincial eligibility requirements and program descriptions.

Medical school transcript

A medical school transcript is a list of marks from a student’s undergraduate medical education. For medical school transcripts, a placeholder is automatically created in all students’ accounts in CaRMS Online for the document to be uploaded.

Graduates of Canadian medical schools

Applicants can submit their medical transcript in one of two ways:

  1. They can obtain and upload the document themselves into their CaRMS Online account; or
  2. Ask their medical school to upload the document using the CaRMS Online Undergraduate Portal.

If applicants have previously participated in the R-1 match since 2013, their previous documents will appear in their current profile.

Graduates of international medical schools

Applicants can submit their medical transcript in one of three ways:

  1. Transfer the document from; or
  2. They can obtain and upload the document themselves into their CaRMS Online account; or
  3. Ask their medical school to upload the document using the CaRMS Online Undergraduate Portal.

If applicants have previously participated in the R-1 match since 2013, their previous documents will appear in their current profile.

International schools who do not have a CaRMS Online Undergraduate Portal account can submit a request to

Medical Student Performance Record (MSPR)

The MSPR/dean’s letter is a letter of standing from the dean or principal of the medical school.

Typically, this document:

  • Reports on activities during medical school; and/or
  • Comments on performance in clinical rotations; and/or
  • Gives a recommendation for further medical training; and/or
  • Reports on time spent in each specialty or department (hours or weeks).

Graduates of Canadian medical schools

In general, CaRMS receives MSPRs for graduates of Canadian medical schools participating in the R-1 match directly from universities.

Current year Canadian graduates’ MSPRs are usually transferred automatically, but students must ensure they follow their university’s processes for their documents to be transferred to CaRMS and should check the document tracking section of CaRMS Online to ensure the documents are in place.

Prior year Canadian graduates applying to CaRMS for the first time must ask their university to transfer their MSPR to CaRMS via the school’s CaRMS Online Undergraduate Portal account.

Graduates of international medical schools

Students can upload their own MSPR/dean’s letter if they have it in their possession. International medical schools can also use our Undergraduate (UG) Portal to upload MSPR/dean’s letters. Medical schools can register for the UG portal by contacting

Personal letters

Personal letters are how applicants introduce themselves to programs and how they express interest in a specific program and/or discipline.

Personal letters should outline the reasons an applicant has chosen a particular training program. Each program has preferences regarding what the personal letter should contain, so we encourage applicants to check individual program descriptions for more information.

Student’s must enter personal letters directly into CaRMS Online. However, they can use an offline word processing program and paste the text into CaRMS Online once it is complete.


If programs would like to receive a photograph, they will indicate this in their program description. The photograph is intended to be used as a reminder to help programs identify applicants at the time of ranking and will not be visible to programs until the beginning of the interview period. A professional head shot should be used wherever possible.

Students must upload their photograph directly into their CaRSMS Online account in JPG format and it should be less than 2 MB in size.

Extra documents

Applicants can include any additional documents they feel will enhance their application, including custom resumes (CVs), evaluation rotations, etc.

If programs would like to see specific documents or do not want to review any extra documents, these preferences will be indicated in their program description so we encourage students to review program descriptions before assigning extra documents.

Applicants should only upload documents into the extra documents category if another appropriate category does not already exist.

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