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    Supervisor Data 2020

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    naheedahmed
    This document appears to be a registration form for physicians and surgeons seeking registration with the Pakistan Physicians and Surgeons Research Cell. It requests personal information such as name, qualifications, educational workshops attended, teaching assignments, and requires supporting documents like CV, registration and license copies, recommendation letters, and workshop attendance certificates. The applicant must also provide a faculty list from their institution and pay any membership dues owed.

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    Supervisor Data 2020

    Uploaded by

    naheedahmed
    6 views2 pages
    This document appears to be a registration form for physicians and surgeons seeking registration with the Pakistan Physicians and Surgeons Research Cell. It requests personal information such as name, qualifications, educational workshops attended, teaching assignments, and requires supporting documents like CV, registration and license copies, recommendation letters, and workshop attendance certificates. The applicant must also provide a faculty list from their institution and pay any membership dues owed.

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    Original Title

    supervisor-data-2020

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    This document appears to be a registration form for physicians and surgeons seeking registration with the Pakistan Physicians and Surgeons Research Cell. It requests personal information such as name, qualifications, educational workshops attended, teaching assignments, and requires supporting documents like CV, registration and license copies, recommendation letters, and workshop attendance certificates. The applicant must also provide a faculty list from their institution and pay any membership dues owed.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    6 views2 pages

    Supervisor Data 2020

    Uploaded by

    naheedahmed
    This document appears to be a registration form for physicians and surgeons seeking registration with the Pakistan Physicians and Surgeons Research Cell. It requests personal information such as name, qualifications, educational workshops attended, teaching assignments, and requires supporting documents like CV, registration and license copies, recommendation letters, and workshop attendance certificates. The applicant must also provide a faculty list from their institution and pay any membership dues owed.

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    of 2

    FORM "B'' Gou_rGE 0r REGISTRATION

    T PHYSIGIAIUS AND
    AIIID SURGEIINS RESEARCH

    SUPERVISOR'S DATA PAKISTIIT CELL

    o
    PERSONAL DATA
    D D

    FULL NAME

    FATHER'S / HUSBANO'S NAME


    PASTE
    COLOUR PHOTO
    OATE OF BIBTH

    DESIGNATION

    INSTITUTION

    SPECIALITY

    MAI Ll NG ADDR ESS (RESroENrrAL oNLy)

    PHONE (BES) HOSPITAL cLtNtc

    MOBILE FAX EMAIL

    OUALIFICATIONS 'Quatiticattons awaded honotadty shoukt not be mentionect

    OUALIFICATIONS' YEAR INSTTTUTION (RESIDENTIAL ONLY)

    EDUCATIONAL WORKSHOP ATTENDED (rFyEs,crvEDArEs) (cnossourrHosENorArrENoED)

    TTILE OF WORKSHOP YES NO YEAR PLACE

    1. EDUCATION PLANNING & EVALUATION

    2. ASSESSMENT OF COMPETENCE

    3. SUPERVISORY SKILLS

    4. BESEARCH METHOOOLOGY

    5. OTHERS
    TEACH I NG ASSI GNM ENTS rsnnrrrua FRoM pHEsENr posr)
    POST HELD INSTITUTION DUHATION wlTH OATE
    FR Oi/l TO

    Plers€ encloge ths lollorYing:

    1. Curriculum Vitae

    2. Photocopy ol valid & updated PMDC Begistration

    3. Photocopy of appointment letter of present position

    4. Flecommendation retter by Principalr-lead ol the lnstitutron

    5. Faculty list: Please mention lhe names ol the faculty memoers in each unil in the speciality and number ot trainees
    registered under each (Singed & Stamped by Head ot hstitute)

    6. Photocopies ol mandatory workshops for supervEors te


    a) Educatronal planning & Evaluation
    b) Assessment ol Comp€tence
    c) Supervisory Skills
    d) Flesearch Methodology. Biosiatastics & Medical Wltrng

    E) BLS / ACLS. BLS,'PALS, ATLS, ALSC

    7. Photocopy of Post Feliowship Teaching Experience Certrttcate

    L Photocopy of Fellowship Degree

    9. Dues for Good slandrng Fellows (Please contacl CPSP Frnance Deparlment for clearance)

    10 Acknowledgement o, 50 Mcos (Heviewed)

    Date SIGNATUBE WITH STAMP

    FOR OFFIGE USE O[tY

    7" Central Streel, Delence Housing Authonty. Phase ll, Karacha-755oo: Tel 992664OG1 0: 99266446-9
    Telegrarr: Collphysurg, Web: www.cosp.edu.pk, E,mail: rtmc@cpsp.edu.pk

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