UCL MEDICAL SCHOOL Department of Primary Care and Population Health Community Based Teaching Care of the Older Person - September 2015 to June 2016 Wednesday & Thursday 9.30am-12.30pm Placement 1 WED 16 Sep 23 Sep 30 Sep 7 Oct THUR 17 Sep 24 Sep 1 Oct 8 Oct Placement 2 WED 14 Oct 21 Oct 28 Oct 4 Nov Placement 4 WED 16 Dec 6 Jan 13 Jan 20 Jan THUR 17 Dec 7 Jan 14 Jan 21 Jan Placement 5 WED 27 Jan 3 Feb 10 Feb 17 Feb Placement 7 WED 13 Apr 20 Apr 27 Apr 4 May THUR 14 Apr 21 Apr 28 Apr 5 May THUR 15 Oct 22 Oct 29 Oct 5 Nov THUR 28 Jan 4 Feb 11 Feb 18 Feb Placement 8 WED 11 May 18 May 25 May 1 Jun THUR 12 May 19 May 26 May 2 Jun Placement 3 WED 11 Nov 18 Nov 25 Nov 2 Dec THUR 12 Nov 19 Nov 26 Nov 3 Dec Placement 6 WED 24 Feb 2 Mar 9 Mar 16 Mar THUR 25 Feb 3 Mar 10 Mar 17 Mar Placement 9 WED 8 Jun 15 Jun 22 Jun 29 Jun THUR 9 Jun 16 Jun 23 Jun 30 Jun We can commit to leaching on the dates indicated above (please tick) Practice name: Address: Name(s) of tutor(s) who will be teaching COOP: Practice Manager and/or administrative email addresses: Telephone number: Number of students I can take: (4-6) Signature: Date Please return this form ASAP either by email carol.lynch@ucl.ac.uk or by post to the address below: Thank you Carol Lynch Dept. of Primary Care & Population Health, UCL Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF