The Triangle, Roosevelt Drive
Headington, Oxford OX3 7XP
Tel: 01865 740640
Fax: 01865 740641
Application for Funding from the GP Specialty Trainee
Educational Allowance (for GP posts only)
GP Training Number
OXF/800/
VT Scheme
Name
Home Address
Email
Telephone
Practice Address
Type of Training Post
Start Date of Current GP Post
Completion Date of Current GP
Post
F/T or P/T (%)
ST1
□
ST2
□
ST3
□
GP Education Fellow
□
Extension
□
The Triangle, Roosevelt Drive
Headington, Oxford OX3 7XP
Tel: 01865 740640
Fax: 01865 740641
Details of Course
Course Name:
Deanery Course
□
External Course
□
If external, name of organisation offering training:
Dates of Course
From:
To:
Educational Need (from
PDP)
Cost of Course
GPStR Signature:............................................................
Date:.......................................
Approved by GP
Trainer
Date:
Please print name
Approved by GP
Programme
Director
Date:
Please print name
Approved of
Deanery
Date
Please print name
(All signatures to be on same page)
No faxed/emailed forms accepted
Download and print off copies of this form:
http://www.oxforddeanery.nhs.uk/specialty_schools/school_general_practice/courses.aspx
Please send completed forms to:
Barbara Gow
GP School Manager
Oxford Deanery
The Triangle
Roosevelt Drive
Headington
Oxford
OX3 7XP