Primary Care Teaching expression of interest
Thank you for your interest in becoming a GP Educator with the University of Sheffield. We
would like to gather some information about you and your teaching interests.
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Forename *
Surname *
Email address *
Have you completed your MRCGP? *
*If no please describe your current level of training
Do you currently work in a GP practice? *
Please tell us which GP practice you regularly work in (please list all practices here)
Are you either currently or have you previously been a GP tutor or GP supervisor for medical students on placement?
 *
*If you have previously but are not currently please detail your previous teaching experience
What kind of teaching opportunity are you interested in? Please see this link for some general information about the teaching we provide - https://bit.ly/GPteaching
 *
What teaching experience do you have? *
Do you hold any teaching qualifications (please provide details) *
If you have a University of Sheffield vendor number please enter it here
I am happy for you to hold my data for the purpose stated. I understand I can
withdraw my consent at any time and the information will not be shared with third parties. *
Required
Are you subject to any disciplinary proceedings or do you any limitations on your clinical practice? *
Do you have any unspent criminal convictions? *
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