Plymouth GPVTSST3 Scholar Programme 2018

Name:
Qualifications:
Email address:
Mobile phone number:

Deadline for submission: 1200, Monday 26 February 2018

Please submit this form by email to:

Available Scholarships

Patch Leadership Scholarship Programme / 1
Patch Education Scholarship Programme / 1

Which scholarship are you applying for?

If you are applying for multiple scholarships, please put them in order of preference:

1.
2
Name of Educational Supervisor: / Email address:
Name and patch of ST3 practice: / Email address:
Name of Training Programme Director: / Email address:

Declarations:All boxes must be checked to confirm the below. It would be considered a probity issue of the highest order if these confirmations were later found to be false.

I declare that I have written confirmation from my ES that they approve of me applying, that it is in my PDP and will support me in my scholarship. I approve HESW Peninsula to contact them to confirm this.

I declare that I have written confirmation from my TPD that they approve of me applying, and will support me in my scholarship. I approve HESW Peninsula to contact them to confirm this.

I confirm that I have only ever had satisfactory ARCP review outcomes.

I have access to a car and am able to drive to complete my scholarship commitments.

Please provide evidence for each of the below selection criteria. We strongly encourage you to consider the person specification on the website. You may use bullet points and you should write no more than 150wordsper box. Words over the limit will be discounted.

AWhat I have contributed to the development of Clinical Carein my GP training so far.
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BWhat I have contributed to the development of Medical Education in my GP training so far.
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C Publications I have had in Journal/ Letters/ Review/ Newsletter/ Other
Word count:
DPresentations delivered in my GP training so far.
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E What I want to achieve if I am successful in gaining a Scholarship. ( Please refer to your preferred scholarship when answering this question )
Word count: