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Frcs Application

Sample of FRCS application latest

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199 views3 pages

Frcs Application

Sample of FRCS application latest

Uploaded by

mvh6c6jspn
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF or read online on Scribd
ROYAL COLLEGE OF PHYSICIANS AND. FOR OFFICE USE ONLY SURGEONS OF GLASGOW | Person !0No: Se pple? Candidate Examination No Examination Application Form for Confirmed plce?: Yes/No FRCS (Ophthalmology) PART 3 if No, wating lit postion Section 1 ~Personal Details , Surmame/Family Name: Alnuz. (block capitals) Other Name(s): Ak P ite: OY (block apt) Gender (delete as applicable): Male / Female~ Date of Birth: 1£/03/ | 929 Section 2 Contact Details Full Postal Address (block capitals: AE DENS, VIKAS NAGAR 146 Gp DATTA THANAM P- 0, KOLLAM, KERALA Posteode:__ 650.20 2. e-maitaddress: AYTaAkhcdcru x @ yahoo Cor Telephone (ine dialling code): =» Mobite: 47/98 2206//0 Section 3 ~ Examination Details Candidates who have a place on the examination will not be permitted to change the centre they have been allocated to. BANGALORE 3" 6" February 2024 Fees must only be submitted if the Examinations Unit confirms by email that you have obtained a place on the examination. You are then required to submit the exam fee within 2 weeks and no later than the date provided in the email. if your payment is not received by this date, your offer ofa place will be cancelled and the place allocated to a candidate on the walting list. Section 4-tigibitty F1CO ROUTE - PASSED FICO CLINICAL MARGY 2022. Details of passing Part 2 FRCS Ophthalmology: Centre: Date:__/__/__ Details of prior entry to this examination (if applicable): Date ff Centre: Person ID Number (if known): Section 6 - DECLARATION (To be signed by ALL candidates) ‘have read and understood the current examination Regulations and understand the eligibility criteria and! ‘now confirm that to the best of my knowledge all the information given on this form isa true statement of fact. Signature of Applicant vate tj /2 ; 2023 EQUAL OPPORTUNITIES MONITORING The Roya Collegeof Physicians and Surgeons of Glasgow alms to ensure alr treatment in elation to admission and assessment of examination candidates. Completing ths form wil allow us to monitor our statistics and ensure that we are delivering 2 fair examination to all eandidates, tnline with Uk legisation and good practice guidlines, we ae asking all applicants to complete tis section ‘You are not obliged to provide any of the information inthis section, but f yu do so, twill enable us to ‘manitor our business processes and ensure that we provide equality of opportunity to al. This information will, ‘be recorded electronically with your other data in accordance with the UK Data Protection Act 2018 and the ‘General Data Protection Regulation, but used only for monitoring our business practices. Gender Female © Male ransgender © Prefer nottosay Marital status Single ‘waried © Cohabiting 5 hal partnership 1 Separated/divorced 5 Widowed © Prefer not to say Do you consider your first language to be English? ‘es 0 No 5 Prefer not to say ethniity Choose one selection from the list below to indicate your ethnic group or background. a) White (English/ Welsh/Scottih/Norther rish/Brtish © ish {Gypsy or Ish Traveller ‘Any other White background (wt in) b) Mixed / Multiple ethnic Groups ‘White and Black Caribbean ‘White and Black Ain 0 White and Asian Any other mixed background (write in) «9 Aslan or Asian British Bangladeshi 1 chinese Indian © Pakistan Any other Asian background (write in) 4) Black or Black Bish © aftcan © Carlbbean Any other Black background €) Other Ethnic Group arab Any athe ethnic background (writ © Prefer not tosay Whats your religion or elit? © Buddhist

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