GP Practices Register your interest in hosting a student for a Primary Care Elective Summer 2021

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* 1. Practice name

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* 2. Contact email address

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* 3. Name(s) of QUB GP Tutor(s) to take part

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* 4. What Federation Area are you part of?

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* 5. If you have already been approached by a student for an elective experienced and it has been arranged let us know the details here.

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* 6. What are your preferred dates between July and August 2021? (4 week placements provisionally with some scope for 2 week placements if students have other electives arranged also)

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* 7. Would you have capacity to take 2 students at the same time or with some overlap?

Yes

No

Other (please specify)

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* 8. Can your practice provide the opportunity for bespoke teaching for students in other specialty areas e.g Dermatology/MSK? If yes please explain below:

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* 9. Any other comments