Visiting Professional Programme application form

How did you find us/hear about the Visiting Professional Programme?(Required)

Please specify how you found/heard about the Visiting Professional Programme(Required)

Are you applying for an observership or clinical attachment?

Please note in order to apply for a clinical attachment you will need to be GMC registered

Please select which programme you are applying for?(Required)

How many weeks would you like to come for?

Please enter a number greater than or equal to 12.

When would you like to start the programme?(Required)

We require a minimum of 12 weeks’ notice to be able to process your application so please consider this when selecting your start date

Name(Required)

First Last

Email(Required)

An email address we can get back to you on.

Telephone

A telephone number we can contact you on.

Address

Address line 1 Address line 2 Town / City ZIP / Postal Code Country

Your qualifications(Required)

Please provide details of your Medical Degree and any other relevant qualifications you hold

Professional experience(Required)

Please outline your previous experience, relevant to this attachment

Personal statement(Required)

Please say how attending this Visiting Professional Programme will benefit you and why you wish to attend this programme

My clinical objectives(Required)

Please list (on separate lines) the 5 most important clinical objectives you wish to gain from the programm

Name of current job role/post(Required)

Name of institution/employer and address(Required)

Supervisor's name(Required)

First Last

Supervisor's job role/post(Required)

Supervisor's email address(Required)

Supervisor's telephone

I can confirm that I have read and accept and understood the Guy’s and St Thomas’ NHS Foundation Trust privacy policy.

Page last updated: 18 May 2023

Cookie settings