External ES - location preference questionnaire

External Educational Supervisor- Location Preference Questionnaire
Please complete this questionnaire only if you want your name and email address added to FPM's list of external educational supervisors, which is made available on request to pharmaceutical medicine organisations that require an educational supervisor.
Full name*

TitleForenameSurname
GMC registration no.*
Email address*
example@example.com
Are you willing to travel to England to supervise trainees?

YesNo
Which regions of England are you willing to travel to supervise trainees?

North EastNorth WestYorkshire and HumbersideEast MidlandsWest MidlandsLondonSouth EastSouth WestAll regions
Are you willing to travel to Scotland to supervise trainees?

YesNo
Which regions of Scotland are you willing to travel to supervise trainees?

Central ScotlandGlasgowHighlands and IslandsLothianMid Scotland and FifeNorth East ScotlandSouth ScotlandWest ScotlandAll regions
Are you willing to travel to Wales to supervise a trainee?

YesNo
Which regions of Wales are you willing to travel to supervise trainees

North WalesMid WalesWest WalesSouth WalesAll regions
Are you willing to travel to Northern Ireland to supervise trainees?

YesNo
Which counties of Northern Ireland are you willing to travel to supervise trainees?

AntrimArmaghDerry/LondonderryDownTyroneAll counties
Are you willing to travel within the European Economic Area (EEA) to supervise trainees?

YesNo
Which countries within the EEA would you be willing to travel to supervise trainees?

AustriaBelgiumBulgariaCroatiaRepublic of CyprusCzech RepublicDenmarkEstoniaFinlandFranceGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMaltaNetherlandsNorwayPolandPortugalRomaniaSlovakiaSloveniaSpainSwedenAll countries
Are you willing to travel to Switzerland to supervise trainees?

YesNo
Should be Empty:

External Educational Supervisor- Location Preference Questionnaire