given of the date that I intend on returning to the clinical programme and that the placement will depend on availability at that time. I understand that I may have to wait for a placement. I will need to return an annual out of programme report for each year that I am out of programme for consideration by the annual review panel. This will need to be accompanied by an assessment report of my progress in my research or clinical placement. Failure to do this could result in the loss of my training number. I will need to give at 3 months’ notice to the Postgraduate Dean and to my employer before my time out of programme can commence. Signed __________________________ Date ________________________ (Trainee) Print name Signed __________________________ Date_________________________ (Educational Supervisor) N.B: Signature required from Regional Advisor for Anaesthetics Trainees Print name Signed __________________________ Date_________________________ (Training Programme Director - TPD) Print name New requests: the Postgraduate Dean will only sign this document it has been signed by the trainee’s education supervisor and Training Programme Director. On-going OOPs: this document should be signed by the TPD and will need to be submitted to the ARCP panel. Signed: __________________________ Date: _________________________ (Postgraduate Dean (or deputy)) Please return to: by 5th January 2018. After 5th January 2018 please submit forms via via the New Portal:
given of the date that I intend on returning to the clinical programme and that the placement will depend on availability at that time. I understand that I may have to wait for a placement. I will need to return an annual out of programme report for each year that I am out of programme for consideration by the annual review panel. This will need to be accompanied by an assessment report of my progress in my research or clinical placement. Failure to do this could result in the loss of my training number. I will need to give at 3 months’ notice to the Postgraduate Dean and to my employer before my time out of programme can commence. Signed __________________________ Date ________________________ (Trainee) Print name Signed __________________________ Date_________________________ (Educational Supervisor) N.B: Signature required from Regional Advisor for Anaesthetics Trainees Print name Signed __________________________ Date_________________________ (Training Programme Director - TPD) Print name New requests: the Postgraduate Dean will only sign this document it has been signed by the trainee’s education supervisor and Training Programme Director. On-going OOPs: this document should be signed by the TPD and will need to be submitted to the ARCP panel. Signed: __________________________ Date: _________________________ (Postgraduate Dean (or deputy)) Please return to: by 5th January 2018. After 5th January 2018 please submit forms via via the New Portal:
OOP_Application_Form-updated-as-of-15.12.17-3.docx