Form R (Part A) Trainee registration for Postgraduate Specialty Training

Personal Details

This part of the survey uses a table of questions, 

Forename:
GMC-registered surname:
Immigration Status:

(dd/mm/yyyy)

This part of the survey uses a table of questions, 

Current Home Address:
Required
First Line:
Second Line:
Town/Region:
County:
Post Code:

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

(dd/mm/yyyy)

NTNs are currently under review by the GMC so if you have not yet been provided with a NTN you can leave this field blank.

I can confirm that my certificate route is:

Date of entry to Grade/Programme (dd/mm/yyyy) (Substantive date started in programme of appointment) - Enter the date you started your programme or grade here.

(dd/mm/yyyy)

Provisional CCT Date (or CESR/CEGPR where applicable), if known, not relevant to Trainees in Core Training Programmes, LATs or FTSTAs This date should be the date you expect to complete your training if you are in a run through or higher specialist programme.

Dates need to be in the format 'DD/MM/YYYY', for example 27/03/1980.

Please make sure the date is between 01/01/2005 and 31/12/2100.

(dd/mm/yyyy)

End of Part A

Next you need to complete Part B

If you submit your answers you will not be able to return to this page.