CEP Application Form 2023

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1.1. Last Name Required

2.2. First Name Required

3.3. Email Address Required

Please enter a valid email address.

4.4. Contact telephone number Required

5.5. Grade or Job Title Required

6.6. Main Employer Required

7.7. Tell us why you would like to register for the Clinical Educator Programme Required

Career progression

CCT preparation

Develop as an educator

RoT as a Clinical Supervisor

RoT as an Education Supervisor

I understand that the information above will be used for GMC return purposes and my e-mail address could be used to contact me in relation to the Clinical Educator Programme. (Please read the privacy statement at http://www.clinicaleducator.org/page/privacy-statement.)

Please accept completion of this form as my consent.