Intermediate Competency registration form

"*" indicates required fields

Title

First name*

Surname*

Job title*

As stated in your job description - nurse/doctor is insufficient information

Place of work*

Name of clinic, hospital or practice Street Town/City County Postal code Country

Training location

(If different to your place of work)

Name of clinic, hospital or practice Street Town/City County Postal code Country

Your NHS Trust*

Telephone number*

Email*

GMC Number

HCPC Number

NMC Pin

Trainer details

Name of Registered Competency Trainer*

Refer to https://www.stif.org.uk/sti-foundation-competency-trainer/

Trainer's place of work*

Name of clinic, hospital or practice Town/City County Postal code Country

Trainer's Email*

Please select the ONE option which best relates to you*

I have attended a STI Foundation Theory course in the last 3 years.

I have completed the Faculty of Reproductive & Sexual Health 'Course of 5' in the last 3 years.

I have attended an alternative theory course within the last 3 years approved by my Registered STI Foundation trainer.

I am currently working within a Level 3 GUM Service and have attended in-house theoretical training that is approved by my Registered STI Foundation trainer

Please state the location and date of your STI Foundation Theory Course

Please state the date of course (month and year only)

Please state the details of your course, including the date (month and year only)

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Options
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Category: STI Foundation Competencies

Intermediate Competency registration form

Trainer details

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