Thank you for applying to be a GP Champion.
 
This questionnaire will take <5 minutes to fill out and we will email you to confirm your participation in the scheme and outline what happens next.
 
If you have any further questions or would like a copy of our FAQs please email gpcareerschampions@gmail.com
 
Thank you,

Meg Rowlands & Anna Harrison
GP Leadership Trainees
South West Deanery

Please enter any personal details you are happy to be contacted by

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* 1. Please enter any personal details you are happy to be contacted by

Please enter your main GP Surgery address (work address)

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* 2. Please enter your main GP Surgery address (work address)

What stage in your career are you at currently

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* 3. What stage in your career are you at currently

What is your career background and do you have any particular interests? (eg background in sugery, GPwSI etc)

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* 4. What is your career background and do you have any particular interests? (eg background in sugery, GPwSI etc)

Would you rather be a Champion to:

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* 5. Would you rather be a Champion to:

What level of support would you be happy to offer? (Tick as many as apply)

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* 6. What level of support would you be happy to offer? (Tick as many as apply)

Do you feel you need any extra information or support to fulfil this role?

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* 7. Do you feel you need any extra information or support to fulfil this role?

Any other questions or comments about the GP Careers Champion scheme? We will answer these by return email.

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* 8. Any other questions or comments about the GP Careers Champion scheme? We will answer these by return email.

Please select to confirm your participation:

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* 9. Please select to confirm your participation:

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