Mock Candidates Required for OSCE Station Rehearsal

Mock Candidates for 2025.2 Fellowship OSCE

Please fill out this form to express your interest in the above role.
Name*

First NameLast Name
ACEM ID*
Phone Number*
Your Email*
Are you a current ACEM Fellow?*

YesNo
You must be an ACEM Fellow to participate in this event.
Date Fellowship obtained*

DayMonthYear
Date
You would be required to attend for approximately two hours on the morning of the exam. Please note travel costs are not covered by the College. Your participation will be recorded as CPD activity.
I acknowledge that the College will not cover any travel costs associated with undertaking this role*

YesNo
Have you participated as a mock candidate previously?*

YesNo
Which days are you available?*

Tuesday 9 SeptemberWednesday 10 SeptemberThursday 11 SeptemberFriday 12 September
What is the maximum number of days you would be interested in attending as a mock candidate?*
Any additional comments?
Confidentiality Agreement

Please read the Confidentiality and Intellectual Property Agreement (attached below):
Acknowledgement
By submitting this form I acknowledge the following terms:*

I agree to the terms of the Confidentiality and Intellectual Property Agreement attached above and agree to abide by this
Signature*

Powered by Jotform SignClear
Should be Empty:

Mock Candidates for 2025.2 Fellowship OSCE