Department (City and Country)

Head of Department

Educational Supervisor

Telephone (inc code)

Cellphone (inc code)

Fax (inc code)

E-mail

1. Are you interested in receiving visiting trainees?

2. Areas of clinical interest / expertise

3. Language/s used for teaching:

4. Is the Department currently teaching?

5. At what level is teaching carried out?

6. Is the Department accredited as an official training center in your Country?

7. Period for which your Department is able to accept visiting trainees:

8. Could your Department offer financial support or payment for work to a visiting trainee?

9. Could your institution arrange accommodation for a visiting trainee?

10. 'Hands-on' experience offered