UCL MEDICAL SCHOOL
Community based teaching
DEPARTMENT OF PRIMARY
CARE & POPULATION HEALTH
APPLICATION FOR TEACHING EQUIPMENT FUNDS
Date of application
/
/ 20
Name:
Practice Name:
Address:
Telephone:
Fax:
Email:
Please list your current and/or proposed undergraduate teaching activities and those of your practice as a whole:
Please describe the teaching equipment which you wish to purchase:
What is the estimated cost?
What proportion of this equipments’ use will be dedicated to undergraduate teaching?
Please outline how this equipment will contribute to student learning in your practice:
Please return completed form to Rushmi Pelpola either by email or to the address below.
Department of Primary Care and Population Health, Community Based Teaching
UCL Medical School, Royal Free Campus, Rowland Hill Street, London NW3 2PF
 +44 (0)20 7472 6449  +44 (0)20 7472 6871  r.pelpola@ucl.ac.uk  http://www.ucl.ac.uk/pcph/undergrad/cbt/