Undergraduate Electives Placement

Demographic / current study details

Student forename ^*

Student surname ^*

Likes to be known as

Medical school email address only ^*

Current programme of study ^*

Trained at EKHUFT before? ^*

Yes No

Speciality preference 1 ^*

Speciality preference 2

Site preference 1 ^*

WHH QEQMH K&C

Site preference 2

WHH QEQMH K&C

Current year of study ^*

Placement start date ^*

Placement end date ^*

Are you related to a Trust board member or senior member of staff within the organisation? ^*

Yes No

If YES, please state who

Reasons for applying to East Kent Hospitals University NHS Foundation Trust and these specialities ^*

Please enter a maximum of 500 words.

Immigration status. Are you a UK national? ^*

Yes No

Do you have evidence of entitlement to enter and work in the United Kingdom? ^*

Yes No

What is your nationality given on your passport? ^*

Have you pre arranged a supervisor? ^*

Yes No

Do you require accommodation with us? ^*

Yes No

If YES please state name

If YES - please state supervisor email

Supporting documents

(reference from current medical school, English language qualification, CV, evidence of entitlement to enter and work in the United Kingdom, If not UK, please upload a scanned copy of your passport)

Upload all of your supporting documents

Drop files here or click to upload