CPD Funding : Surrey Training Hub

Applicant Name

Applicant Role/Profession

Practice Name

PCN

Date started in role

Course Title

Course Provider

Start Date

End Date

Total cost of course

Amount Requested

Manager Name

Manager Email Address

How does this training meet your learning and development needs?

What will you be doing differently as a result of the training?

Has this training been agreed by your manager and recorded in your appraisal?

Describe how this course is aligned to local and/or national priorities.

Please detail how this will support delivery of patient care in line with the above.

How (and with whom) will you share your learning following completion of the course/training?

Do you hold a qualification that enables you to supervise or assess students? Eg PA/PS/RMSV/clinical

How many student placements have you supported over the last 12 months?

For HCAs only:

Have you completed the Care Certificate?

Do you hold a Health and Social Care qualification i.e.: NVQ

If yes, choose one:

Level 2
Level 3

General Practice Assistant Programme