British Paediatric Neurology Association distance learning

Download 8.63 Kb.
Size8.63 Kb.

British Paediatric Neurology Association


Application Form to begin course January 2010

Instructions (any difficulty please email or telephone 01204 492888):

  1. a) On your browser click ‘File’ and then ‘Save As’. Save this form to your computer.

  1. Save the file again as ‘File Name: your surname and initials’ and ‘File Type: Word Document

  1. a) Complete the personal details section.

  1. Complete ‘Why you would like to do the BPNA distance learning course’ (100 word limit).

  2. Paste a copy of your cv on to the end of the form.

  3. Save the document.

3. Email the completed document as an attachment to:

4. Closing date for applications is 31 October 2009.

Personal Details:

Title: First Name: Surname:

Hospital employed at:


Address for correspondence:


Work Telephone: Home Telephone:



Grade: Trainee / Career Grade

If Trainee, CCST Date: _______________ Are you in a National Grid Post? Yes / No

Why would you like to do the BPNA distance learning course?

Please write why you would like to do this course in no more than 100 words:
I would like to do the British Paediatric Neurology Association’s distance learning course because

Educational Supervisor:

I have read ‘Information for Educational Supervisors’ ( and have agreed to be the applicant’s educational supervisor if they are offered a place on the distance learning course.
Title: First Name: Surname:


Address for correspondence:


Work Telephone:


Have you attended a distance learning Educational Supervisors’ training?
Curriculum Vitae

Applicant, please paste a copy of your CV here.
Download 8.63 Kb.

Share with your friends:

The database is protected by copyright © 2023
send message

    Main page