College of Physicians and Surgeons of Cardiff

Application to Become a Faculty of the College of Physicians and Surgeons of Cardiff

Expression of Interest to Teach

Professor

Forename*

Surname*

Phone (mobile)*

Email 1*

Email 2

Hospital*

Please enter the name of your hospital*

Enter the name of hospital*

Current Level*

Select Level

Speciality*

Select Speciality

Please enter your speciality

Qualification(s)* (e.g., MRCP)

Qualification

Yes

If the course in which you wish to teach is not listed above, please write the name(s) of the course(s) here:

How often would you like to teach?

Select the duration

If you wish to be involved with the College of Physicians and Surgeons of Cardiff in any other capacity, you may kindly provide the details here. Please provide as much information as possible.

Personal Details

Professional Status

Have you previously attended a College of Physicians and Surgeons of Cardiff or a Doctors Academy event?

Please select the course(s) in which you wish to teach.