Form X confirming the possession of FACD 5.2 or expectation of successful completion of UK Foundation Programme

Instructions to applicants:

Please note:

1.  If you already hold a Certificate of Completion of Foundation Training (FACD 5.2) that was issued on or after the 31st July 2007, please fill in the first part of this form and attach a copy of your FACD 5.2. Please also bring the original of the form in the event that you are invited to Selection Centre.

2.  If you are currently in a UK Foundation Programme and expect to be issued with a Certificate of Completion of Foundation Training (FACD 5.2) between the 18th December 2009 and the 3rd August 2010, please fill in the second part of this form and provide a signed letter from your FP tutor or Educational Supervisor to confirm that they expect you to achieve FACD by the 3rd August 2010. (Please ask your FP Tutor/Educational Supervisor to include the specified fields within the letter).

Please complete and sign the declaration below, and in the event that you are invited to Selection Centre please submit this form along with other requested documentation.

Applicant declaration:
I confirm that I have attached a copy of my FACD 5.2/letter from my FP tutor or Educational Supervisor (delete as appropriate)
Applicant Name
Applicant GMC No / Speciality you are applying to / Public Health
Signature / Application No.
FOR OFFICE USE ONLY
Countersignature confirming final decision agreed by all panel members (please √ as appropriate and panel chair to sign & print name)
Sufficient evidence of (expected) Foundation Competency demonstrated to permit continued assessment via the selection process
OR
Insufficient evidence has been submitted for continued progression in the current recruitment round (give details)
Panel Chair Signature …………………………………………………………………………
Print Name ……………………………………………………………………………
Signed on behalf of Selection Panel

Please tell us what kind of evidence you are submitting with this form. Only one category of evidence is needed:

Y / N
FACD certificate confirming completed F2?
submit photocopy of certificate

OR

:

Letter from FP Tutor or Educational Supervisor confirming expectation of achievement of FACD? / Y/N
If yes, are all the following criteria satisfied? It is essential that your letter includes all of these fields or you will be deemed not to be eligible to apply. This is because it has not been confirmed that you are expected to successfully complete a UK Foundation Programme.
Headed notepaper
Candidate name
Candidate GMC no
Supervisor name
Supervisor signature
Supervisor GMC no
Submit ORIGINAL confirmation

IN THE EVENT THAT YOU ARE INVITED TO SELECTION CENTRE, PLEASE SUBMIT THIS FORM, COMPLETED & SIGNED ALONG WITH THE OTHER REQUESTED DOCUMENTATION.

APPLICANT NAME ______GMC NO.______

PAGE 1 Specialty Training Programmes 2010