Medical Training Initiative (MTI) Checklist for IMG Applications – MTI Matching Scheme Please confirm whether you meet every aspect indicated below, then sign, date and submit the form to the Global Partnerships team for review. If you are having difficulty submitting this webform, please try using either Google Chrome or Microsoft Edge web browsers. If successful, we will start sending your CV to hospitals. Please upload up-to-date IELTS (Academic version)/OET (Medicine) results Allowed types: txt, rtf, pdf, doc, docx only Please upload an up-to-date CV Allowed types: txt, rtf, pdf, doc, docx only Name Email address Country of residence Postgraduate medical qualification Awarding body I have been engaged in medical practice for a minimum of three years out of the last five years outside of the European Union, including the most recent 12 months (with no gaps in the last 12 months). Country Title of post Start date End date Country Title of post Start date End date Country Title of post Start date Current post? Yes No I have an up-to date IELTS certificate with a score of at least 7 in each band and an overall score of 7.5 OR I have an OET with at least a grade B in each component and still valid. Please specify IELTS OET Date (DD/MM/YYYY) I confirm that I have not previously sat the Professional and Linguistic Assessments Board (PLAB) test Further informtion is available here Brief statement of intention upon completing your MTI placement in the UK Please confirm the country where you intend to reside after your MTI post Confirmation of the specialties you are interested in For example, anaesthesia, intensive care medicine or pain medicine I can confirm that the information provided in this checklist is correct and true I understand that any false declaration may result in refusal of the application and the General Medical Council being informed I understand that the Royal College of Anaesthetists reserves the right to refuse my application and that the College’s decision is final I confirm that I have read and understand the General Medical Council and Royal College of Anaesthetists guidelines Signature Please sign above using your mouse or finger (if using a touchscreen device). Date (DD/MM/YYYY) Confirmation Data Protection Statement The Royal College of Anaesthetists (RCoA) is fully committed to the principles of data protection, as set out in the Data Protection Act 2018 (C.12). The RCoA relies on legitimate interests as the lawful basis for processing of personal data. We process and maintain personal data about you so that we can manage your membership, provide you with appropriate products and services and share information with you about RCoA activities. We will only use your information for the purposes as described and will not pass on your details to other third parties unless you have given us consent to do so. We use appropriate organisational and technical measures to ensure that your data are secure and protected from loss, misuse and unauthorised access or alteration. You have the right to ask for a copy of the information we hold about you and to have any inaccuracies in your information corrected. If you have any questions about data protection or require further information, please email dpo@rcoa.ac.uk I have read and understand the College's data protection statement CAPTCHA This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
