The Royal College of Surgeons of England
APPLICATION FOR INTERCALATED BACHELOR OF
SCIENCE DEGREE IN SURGERY FOR MEDICAL STUDENTS
1. Surname:
Forenames (in full):
Title: Male/Female:
Date of Birth: Nationality:
Medical School:
Current Year:
2. Title of study:
Area of Study i.e. respiratory, head and neck surgery:
3. Place where study would take place:
Address of Centre:
E-mail:
Telephone No (inclu. STD
code):
Fax No:
4. Name and title of proposed Head of Department and proposed Supervisor(s):
Head of Department:
1st Supervisor:
2nd Supervisor if
appropriate:
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5. The degree
Title of Research (not more than 20 words):
Summary of Research Program – including study design and methodology, objectives and appropriateness of study for
surgery
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6. Simple description of the proposed research using clear lay terminology, which should be readily understandable to
members of the general public.
This should include the following and should not exceed 100 words:
A simple, heading ‘headline’ – type title (maximum 6 words)
Details of the disease/condition and any associated conditions, ie who suffers, the symptoms and numbers affected
How this research might help those sufferers in the short/long term
The ability of The Royal College of Surgeons of England to award research grants is dependent on the success in raising funds.
7. Financial details: The grant is worth up to a maximum of £5000.
Please set out how these monies are to be spent and to whom payment should be made:
Item: Amount:
Total :
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8. Current home address:
Telephone No (inclu. STD code):
Mobile:
E - mail:
Day-time Telephone No (inclu. STD code and
extension) and FAX No (if available):
Signature: Date:
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PART B
The Royal College of Surgeons of England
APPLICATION FOR AN RCS INTERCALATED BACHELOR OF
SCIENCE DEGREE IN SURGERY FOR MEDICAL STUDENTS
IN THE U.K.
Confidential Report from proposed Supervisor
Applicant’s Name:
Supervisor: The above named applicant has applied for an RCS Intercalated Bachelor of Science degree in surgery
for Medical Students, would you please complete and return, in confidence, TEN COPIES of Part B by the closing
date to either the applicant or to: The Research Board, The Royal College of Surgeons of England, 35/43 Lincoln’s
Inn Fields WC2A 3PE.
1. Describe the manner in which the proposed degree has evolved and the planned contribution of the applicant:
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2. How frequently do you propose to have a structured meeting with the candidate?
3. What will you do to train this applicant? Are there lectures, seminars, tutorials or courses available?:
4. State your views on the candidates scientific ability for research training and any other relevant points which you
consider would be helpful to the College:
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5. Please state your research interests/areas of research activity
6. Name: Title:
(Supervisor)
Address:
Telephone No. (inclu. STD code):
E-mail:
Signature:
(Supervisor) Date:
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PART C
The Royal College of Surgeons of England
APPLICATION FOR AN RCS INTERCALATED BACHELOR
OF SCIENCE DEGREE IN SUPPORT FOR MEDICAL
STUDENTS IN THE U.K.
Confidential Report from a Surgeon working in a hospital linked to your
Medical School
Applicant’s Name:
The above named applicant has applied for an RCS Intercalated Bachelor of Science Degree in Surgery, would you
please complete and return, in confidence, TEN COPIES of Part B by the closing date to either the applicant or: The
Research Board, The Royal College of Surgeons of England, 35/43 Lincoln’s Inn Fields WC2A 3PE.
1. Please could you give a brief reference in support of the Medical Student undertaking an Intercalated Bachelor of
Science degree in a surgical related subject.
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2. Name: Title:
Hospital Address:
Telephone No. (inclu. STD code):
E-mail:
Signature:
(Supervisor) Date:
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