Trainee Study Leave

Your Details

First name ^*

Surname ^*

GMC/GDC Number ^*

Specialty ^*

Grade ^*

Study leave allowances: F2 = 10 days; CT/ST/HST/DCT = 30 days; GPST = 30 days x 10 days per rotation.

Hospital ^*

This must be an NHS.net email

Programme ^*

Note: Please take care entering your Programme correctly otherwise your request will be instantly rejected.

Contact telephone number ^*

Contract details

Please note this does NOT relate to Rotation Dates

Contract Start Date ^*

Contract End Date ^*

Study leave request

Request is for ^*

Course Conference Exam Private Study GP ES Review

Request type ^*

Mandatory Optional Aspirational

Select the correct type as per HEE Guidelines. The HEE guidelines for Aspirational Study Leave Events are: TPD approval will need to be sought and an aspirational course code from HEE issued before the event is booked. All International Study Leave is considered Aspirational. When an Aspirational Code is received from HEE it will give details of which costs they will authorise, this may not be all of the estimated costs included in your request.

HEE Course Code (if applicable) ^*

Please refer to the link for course codes: https://lasepgmdesupport.hee.nhs.uk/support/home?studyleave

Exam date

If applying for an Exam or for Private Study please enter the date of the Exam

Course/Conference/Exam/Private Study Name ^*

Course/Conference/Exam/Private Study Venue ^*

Start Date

End Date

Please make sure you have chosen the CORRECT start and end dates for your Event.

Number of days

Estimated total expenses

Approval

When completing this section, you should ensure that you have sought approval from your rota coordinator and Educational Supervisor prior to completing this form.

I have read, and agree with, the guidance notes

Submitted date ^*

Email address of your DSA / Rota Co-Ordinator

Note: If you're unsure who your DSA / Rota Co-Ordinator is, please contact Medical Education.

Email address of your Educational or Clinical Supervisor

Note: If you're unsure who your Educational/Clinical Supervisor is, please contact Medical Education.

Proof of approval

Please upload proof that this leave request has been approved by the appropriate co-ordinator and supervisor. This will typically be a PDF print copy of an email.

Medical Education

Your contact for Medical Education Trainee Study Leave is: ekhuft.esl@nhs.net