TC White Observership Award Application
Your membership must be in good standing to apply. Click here to join and email dental@rcpsg.ac.uk with any
queries.
Please use typescript or CAPITAL LETTERS when filling out this form
SECTION 1 PERSONAL DETAILS
Title (please circle): Mr / Mrs / Ms / Miss Other _______
Surname:
Forename(s):
Address:
Country: Postcode/zip:
Telephone: Mobile phone:
Email address: GDC No. (If applicable) :
RCPSG PID No.
SECTION 2 APPLICATION DETAILS
Relevant qualifications (please list): Date awarded:
Hospital Unit/University Department for planned Observership:
Head of Department for planned Observership:
Supervisor for Observership if different:
Date of proposed visit:
Description of proposed observation. (200 words maximum.)
November 2020
Personal reflections on the proposed benefits to you. (400 words maximum.)
Reflections on the proposed benefits to your home country/workplace. (150 words maximum)
What transferable knowledge/lessons learned, would you anticipate, to be able to share with the Faculty of Dental Surgery
after your visit? (150 words maximum.)
Please give a brief breakdown of your anticipated financial costs:
November 2020
Please confirm the following:
□ Curriculum Vitae
□ Letter of visit approval from Head of Department being visited (dated within the last 12 months).
□ Tick to confirm you have looked at and meet the eligibility criteria.
PLEASE NOTE: The Head of the Hospital or University Department that you plan to visit must support this application.
If you fail to produce written support, your application will be invalidated.
Closing date for applications to the Dental Faculty: 30 April. Applicants will be advised of the
outcome by 31st July.
A proportion of funds will be released to the successful applicant to help cover travel and accommodation costs. The remaining
funds and receipt of the award will be granted following successful completion of the report and media presentation.
Applicants who have applied for support from other organisations will not be disqualified from consideration for the TC White
Observership Award.
If your application is successful, it is expected that the award will be taken up within 2 years. In addition to providing the
Observership report, to be received within a period of 6 weeks after the visit, the award winner must also provide a 5-minute
multi-media presentation on the benefits of the award.
Declaration
□ I, the applicant named above, confirm that the details provided in this form are correct.
□ I give permission for the success of my application to be published and promoted by the College. The College
reserves the right to leverage maximum publicity/press coverage from any activity funded by this award. We ask
award winners to provide a photo, biography and social media links for promotion activities.
□ I do not give permission for my application for my work to be published.
Signature: ………………………………………………………………………………….. Date ……………………………………….……………
Please return the completed application form with enclosures to:
Dental Faculty Administrator
Royal College of Physicians and Surgeons of Glasgow
232 - 242 St Vincent Street, Glasgow, G2 5RJ
Tel: +44 (0)141 221 6072 Fax: +44(0)141 221 1804
e-mail: dental@rcpsg.ac.uk
All Information concerning you as an individual will be held and processed by the College strictly in accordance with the provisions of the General Data Protection
Regulation (GDPR)(Regulation (EU) 2016/679). Such data will be used by the College to administer its relationship with you as a Fellow or Member. We will not, without
your consent, supply your name and address to any third party except where (1) such transfer is a necessary part of the activities that we undertake, including the
provision of library services (if applicable) or (2) we are required to do so by operation of law. As an individual you have a right under the General Data Protection
Regulation (GDPR) (Regulation (EU) 2016/679) to obtain information from us, including a description of the data that we hold on you. Should you have any enquiries about
this right please email membership@rcpsg.ac.uk
November 2020
November 2020
