ࡱ> 9 f}bjbj(( @JhJh( bbbbbvvv8Zv+&nj(tZ D $*******$-0h!+ib " !+bb2+f#f#f# Rbb*f# *f#f#&Q&X!&*+0+%&,1!T1Q&Q&&1bw&p f# !+!+"| + 1 X (:  INITIAL INTERNATIONAL SPONSORSHIP SCHEME (GMC) FORM (To be completed by the applicant) Please read the 911պ guidance to ensure that you applicant can meet all the criteria for this scheme, particularly the Eligibility Criteria. Guidance on the application process can be found on the Clinical Academic Training Office  HYPERLINK "/medicine/study/clinical-academic-training-office/gmc-sponsorship/" website. Please return this form to the CATO Coordinator at  HYPERLINK "mailto:cato@imperial.ac.uk" cato@imperial.ac.uk . Please email  HYPERLINK "mailto:cato@imperial.ac.uk" cato@imperial.ac.uk or call the CATO Office on +44 (0)203 313 7397 if you have any queries. Please attach an up to date up to date Curriculum Vitae when returning this form PERSONAL DETAILS: Name of applicant It is very important that you are consistent in the spelling and order of your names If your name is different to what appears on your primary medical qualification certificate, you will need to provide acceptable evidence of a change of name, such as a marriage certificate, old and new passports before applying for GMC registrationLast/family Name FORMTEXT      Maiden Name (if applicable) FORMTEXT      First/Other Name (s) FORMTEXT      Gender FORMTEXT      Address (this must be a street /full address rather than a PO Box number) FORMTEXT      Telephone number including country code FORMTEXT       Email address FORMTEXT      Do you have specific entry rights in the UK?  FORMTEXT       PROPOSED RESEARCH PROJECT DETAILS (at Imperial College London) Title and grade of the Research ProjectDivision/Specialty of Research Name of Supervising Consultant(s) (Must be an Imperial College Staff Member) FORMTEXT       Name and address of Research Department/Institute  FORMTEXT       Supervisor Telephone number FORMTEXT      Supervisor Email address FORMTEXT       Title and grade of post offered FORMTEXT      Proposed start dateProposed end date FORMTEXT       FORMTEXT      How is the post funded, by whom, and what is the total funding package? FORMTEXT      How do you see your career developing after training in the UK?  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I understand that any false declaration in any part of the application may result in a refusal of the application and the General Medical Council being informed. I understand that Imperial College London reserves the right to refuse my application, or request further documentation and evidence to support my application if it feels it is necessary. I understand Imperial s decision is final in all matters relating to the Sponsorship Scheme. I understand that Imperial retains the right to inform the General Medical Council if any information provided in my application is found to be false or misleading at a later date. I consent to Imperial College London processing and retaining the personal information contained in this application in line with Data Protection legislation NAME:  FORMTEXT      DATE:  FORMTEXT       Please complete and return this form to  HYPERLINK "mailto:cato@imperial.ac.uk" cato@imperial.ac.uk accompanied by your Curriculum Vitae. 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Title 8@ _PID_HLINKSA8vQmailto:cato@imperial.ac.ukvmailto:cato@imperial.ac.ukvmailto:cato@imperial.ac.ukW ]https://www.imperial.ac.uk/medicine/study/clinical-academic-training-office/gmc-sponsorship/  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ\]^_`abcdefghijkmnopqrstuvwxyz{|}~Root Entry F@X@Data [? 1Tablel$1WordDocument @SummaryInformation(DocumentSummaryInformation8MsoDataStoreXXVVMU4CS13SOL==2XXItem  2PropertiesUCompObj r   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q