Name
Are you a licensed medical practitioner in good standing with the GMC and RCoA?
What grade is your current role?
If you are retired from clinical practice, please choose the grade of your most recent role.
Address
College region (please select from the dropdown list)
Please select any areas of interest that you have, that you feel may be useful in being a Refugee Buddy
Please tick all that apply. Interest areas indicated will be used in the pairing process so that, where possible, refugee anaesthetists will be placed with a buddy who has experience in areas in which they have an interest and are keen to develop.
 
Please confirm that you are happy for your contact details to be shared with the refugee doctor with whom you are buddied and that you have capacity to provide support to this individual
Would you prefer to meet with your buddy virtually or face to face (local guidelines permitting)?
Have you undertaken equal opportunities/diversity training?
Allowed types: rtf, pdf, doc, docx

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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


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