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?
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2. Areas of clinical interest / expertise
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3. Language/s used for teaching:

4. Is the Department currently teaching?

5. At what level is teaching carried out?
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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:
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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