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    Application Form

    Uploaded by

    Will Pridmore
    This document is a form for a Dean or senior faculty member to complete to assess a medical student applying for an elective. It requests information about the student's year of study, dates of attendance for their final year, character, academic and clinical abilities, clinical experience, English language proficiency, and any other relevant details. The Dean is asked to sign off on supporting the student's application, either without or with reservation.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Application Form

    Uploaded by

    Will Pridmore
    52 views1 page
    This document is a form for a Dean or senior faculty member to complete to assess a medical student applying for an elective. It requests information about the student's year of study, dates of attendance for their final year, character, academic and clinical abilities, clinical experience, English language proficiency, and any other relevant details. The Dean is asked to sign off on supporting the student's application, either without or with reservation.

    Original Description:

    Useful for University of Glasgow.

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    This document is a form for a Dean or senior faculty member to complete to assess a medical student applying for an elective. It requests information about the student's year of study, dates of attendance for their final year, character, academic and clinical abilities, clinical experience, English language proficiency, and any other relevant details. The Dean is asked to sign off on supporting the student's application, either without or with reservation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    52 views1 page

    Application Form

    Uploaded by

    Will Pridmore
    This document is a form for a Dean or senior faculty member to complete to assess a medical student applying for an elective. It requests information about the student's year of study, dates of attendance for their final year, character, academic and clinical abilities, clinical experience, English language proficiency, and any other relevant details. The Dean is asked to sign off on supporting the student's application, either without or with reservation.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    THE DEAN OF THE FACULTY OF MEDICINE OR AN APPROPRIATE SENIOR FACULTY OFFICER

    IS REQUIRED TO COMPLETE THIS SECTION OF THE APPLICATION FORM

    Name of student: ……………………………………………………………………………………………………………….

    1. The above named student is presently in year ………. of a ………. year programme.

    2. The dates of attendance for the final medical year are ............................... (DD/MM/YY) to ...............................
    (DD/MM/YY).

    3. General assessment of the student's character and conduct:

    …………………………………………………………………………………………………………………………………

    …………………………………………………………………………………………………………………………………

    4. Assessment of academic ability (please circle): BELOW AVERAGE / AVERAGE / ABOVE AVERAGE

    5. Assessment of clinical ability (please circle: BELOW AVERAGE / AVERAGE / ABOVE AVERAGE

    6. Details of clinical experience to date:

    …………………………………………………………………………………………………………………………………..

    …………………………………………………………………………………………………………………………………..

    7. Student’s knowledge of English (where English is not first language):

    Spoken: ……………………………………………………. Written: ……………………………………………………

    8. Any further information which you think might be of assistance:

    …………………………………………………………………………………………………………………………………..

    9. I support without reservation/with reservation (delete as appropriate) the application from this student for the
    proposed elective.

    Signature: ……………………………………. Date: ……………………. Official Stamp of


    Medical School
    Position: …………………………………………………………………………

    Medical School: …………………………………………………………………

    E-mail address: ………………………………………………………………….

    If you have any queries, please email med-sch-visiting-electives@glasgow.ac.uk

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