Mediclinic Doctor Bursary

Where did you hear about the bursary programme?

Are you currently practicing or applying for admission rights at a Mediclinic hospital?

Yes

Personal Details

First Name

Last Name

HPCSA Registration Number

Title

Contact Number (e.g. +27 821231234)

ID /Passport Number

Email Address

Ethnicity

Nationality

Country of Birth

Gender

Male

Female

Other

Course Information

Current University

University Applying For

Current Speciality

Registered Sub Speciality

Course Name

Time Frame (Months)

Course Start Date (e.g. 25/12/2020)

Funded or Non-Funded Post

Funded

Non-Funded

Financial assistance required for timeframe (e.g. 10000.00)

Do you have a training number for this specialisation / sub-specialisation allocated to you?

Yes

Are you registered at the University where you will be conducting the training?

Yes

Supervisor Details

Supervisor's Full Name

Supervisor's Title

Supervisor's Position

Supervisor's Contact Number
(e.g. +27 821231234)

Supervisor's E-Mail

Do you consent that we use your information to share future practice opportunities with you?

Yes

Supporting Documentation

Curriculum Vitae

Letter of Request (Letter from you)

Letter of Support (Letter from the University)

Copy of HPCSA

(Maximum -- MB of uploaded documents in total are allowed)

Mediclinic Southern Africa takes data privacy very seriously, thus to be considered throughout the bursary application process.

By submitting your information, you acknowledge that Mediclinic Southern Africa will be processing your personal information;
Successful applicants’ information will be shared for contractual, legal aswell as legitimate business purposes with various people in Mediclinic Southern Africa and external entities in compliance with the POPIA act and international standards.

Doctor Bursary Application