PSU Application

NOTE: KSS Foundation trainees should access support services via the KSS’s own Professional Support & Wellbeing Service. Please head to https://kss.hee.nhs.uk/kss-foundation/current-doctors-in-training/careers-and-wellbeing-support/ for more information.

Title *

First name *

Last name *

Email Address *

Gender *

I self-identify as: *

Telephone Number *

GMC / GDC / NMC / other Registration Number *

Profession *

Other profession

Stage of training *

Other stage

Position/Grade *

Other position/grade

Job title *

Medical or dental specialty? *

Medical

Dental

Specialty *

Other specialty

Ethnicity *

Specify ethnicity if not above

LETB *

Other LETB

Do you consider yourself to have a disability? *

Yes

No

Prefer not to say

Trust *

Other trust

Place of Primary Qualification *

UK

IMG (International Medical Graduate)

Reason for requesting one-to-one appointment *

Other (please specify) *

Have you ever been in contact with the PSU prior to this application? *

Yes

No

Please provide details: *

How can we support you? *

Re Confirm your email address *

Confirmation *

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