Paediatrics Training in the Yorkshire Region

This form to be completed within 4 months of rotation date. Although every attempt is made to fulfil Trainees requirements, this cannot be guaranteed. Priority is given to core trainees to enable them to complete core training in the first 2 years. The contents of this form will be forwarded to the Deputy Regional Adviser on submission. Date of next rotation - Sept 08 . N.B. Indicated fields are mandatory.
1. Personal Details	2. Core training
Name	Will core training be completed by the end of this rotation?	YesNo
E-mail	If no, what area needs to be completed

3. Interested in National grid posts?	4. Core training to be completed in current rotation and not applying to the National grid?
I will be applying for a national grid post in:	I have completed 6 months in PICU in a middle grade post	Not ApplicabableYesNo
Start Date	At present I am keen to develop a special expertise in:
	Specialist area
	List in order of preference, 3 posts you would be interested in at the next rotation.
	Preference 1
	Preference 2
	Preference 3

Request Form for Future Training Slots