Taster Leave Application - Aims and Objectives Form

An application form must be completed for all taster leave. You must ensure that you submit your Taster leave
request and seek Directorate/rota manager approval, at least 6 weeks prior to your proposed taster leave dates.
Application
FY2
Name: Grade:

Trust: Current Specialty:

Taster Details

Specialty and Trust in which taster days

requested:

Number of days/half days approved:

Aims and objectives of experiencing this

specialty:

Detail how will these objectives be

addressed:

Please attach a copy of your confirmation of acceptance from the specialty you will be spending taster leave in to this
application. (Please see next page)

I confirm that I have agreed these aims and objectives with my Educational Supervisor and the Consultant who
will supervise me during my Taster Leave experience
Trainees Signature Date

Educational Supervisors agreement

Educational Supervisor

Signature Date

Foundation Programme Directors agreement

FTPD Name

Signature Date

Departmental coverage approval

I confirm there are sufficient levels of cover in the department.
Please ensure that you apply for your leave on Accent Leave Manager
Lead Consultant/Rota Coordinator

Signature Date

Supervising Consultant of the taster leave specialty (to be completed at the end of the taster leave period)

Consultant Name

Consultant Signature Date