_____________________________________________________________________ Place of work: ________________________ Work Phone No: _______________________ Signature: __________________________________________________________ Work _______________________________________________________ Please provide a brief but detailed summary of the additional educational experience that has been undertaken here providing specific examples: *Please note that as an educational supervisor supporting an additional attempt you may be contacted to verify this form Confirmation of additional educational experience (to be completed by the training programme director or equivalents) I confirm that the candidate named above has undertaken additional educational experience to prepare them for the above examination as specified in section 3, and I endorse their request for an additional attempt Training Programme Director name _____________________________________________________________________ Place of work:
_____________________________________________________________________ Place of work: ________________________ Work Phone No: _______________________ Signature: __________________________________________________________ Work _______________________________________________________ Please provide a brief but detailed summary of the additional educational experience that has been undertaken here providing specific examples: *Please note that as an educational supervisor supporting an additional attempt you may be contacted to verify this form Confirmation of additional educational experience (to be completed by the training programme director or equivalents) I confirm that the candidate named above has undertaken additional educational experience to prepare them for the above examination as specified in section 3, and I endorse their request for an additional attempt Training Programme Director name _____________________________________________________________________ Place of work:
Appendix_E._Currency_and_number_of_attempts_in_MRCPCH_examinations_Word_form.v.1.4.29.7.17.docx