Trinity College Dublin, School of Medicine

Summer Visiting Elective Programme

CHECK LIST FOR APPLICANT:

Required Documents listed below must be sent by e-mail to:

Please note all documentation must be in English or certified translations

  1. Application Form Page 1: Sections A & B completed by applicantYesNo
  2. Application Form Page 2: Section C Home University Approval

(To be completed by Dean or Designate of Medical School)YesNo

  1. Form 1B Immunisation Records(refer to Appendix B in application form for further details)

(To be completed and signed by your doctor or university health service)YesNo

  1. Laboratory test results from blood samples taken within previous 6 months YesNo
  2. Police Clearance ReportYesNo
  3. Is Malpractice/Liability Insurance provided by your university? *(attach copy if Yes)YesNo
  4. Proof of personal health insurance that will cover you while in Ireland**YesNo
  5. Brief CV andPersonal StatementYesNo
  6. Original Academic transcriptYes No
  7. Proof of TEFL exam results(required only if English is not the language of instruction at home university)YesNo
  8. CHECKLIST printed off and signed by applicantYesNo

I have read and agree to follow the Important Instructions below.

Applicant’s Signature: ______Print Name: ______Date: ______

Maximum Elective period: 4 weeks during the months of June, July and August only
Minimum Elective period: 2 weeks
NB. Requests for electives outside of the above dates and/or durations will not be considered.

*Insurance: If your university does not provide Malpractice/Liability insurance for your elective, you are NOT required to purchase individual Malpractice/Liability insurance in advance and can wait until you know the outcome of your application. ** Likewise, if you do not already have personal health insurance in place, it is NOT necessary to purchase it at this stage of the application process. In this case, please note “Pending” beside Personal Health Insurance on the Checklist. Any offer of an elective will be on condition that you provide proof of personal health insurance and Malpractice/Liability cover in place for your stay in Ireland.

IMPORTANT INSTRUCTIONS:

1.Applications must be submitted by email only to: and the Subject heading must be as follows: “Visiting Elective Application Summer 2018 – (followed by your name)”

2.Attachments in your e-mail: Each original signed document must be scanned and attached in PDF format. If the documents are not grouped into one single attachment, each attachment must be named according to the document type (eg. Application Form.pdf, Immunisation form.pdf, police cert.pdf, insurance.pdf, etc.)Please use Zip File where possible to reduce the size of attachments.
All required documents from the checklist must be included. Incomplete applications will not be processed.

3.If you do not follow the above Important Instructions, the processing of your application will be delayed. Due to the high volume of requests we receive, it is not possible to provide a status update on the progress of your application during the application period.Please do NOT contact the hospital departments. All general queries regarding the application requirements must be sent to

November 2017