MCFP(S) by Assessment – College of Family Physicians Singapore

(A) Personal Particulars

Name

Nationality

Others - Nationality

Gender

Passport / NRIC No

Date of Birth (dd/mm/yyyy)//

Race

Others - Race

Residential Address

Postal Code

MCR No

Telephone (Home)

Fax (Home)

Mobile Phone

Email Address

(B) Others

YEAR AND DEGREES/DIPLOMAS AWARDED
*Please enclose a copy of your CV

YEAR

QUALIFICATION

Single Line Text

File Upload

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(C) Entry Criteria

Must fulfill all of the following

Is an Ordinary or Associate Member of the College of Family Physicians Singapore for at least 2 years

Yes
No

Relevant Details

Has held a registrable or acceptable qualification for not less than 3 years

Yes
No

Relevant Details

Has been engaged in family practice for not less than 3 years, and is currently in family practice for the past 1 year

Yes
No

Relevant Details

Has spent at least 3 months in primary ambulatory care within the last 3 years

Yes
No

Relevant Details

Letter of professional good standing from a holder of MCFP(S) or above

Yes
No

Relevant Details

Possesses MRCGP(UK) AND GDFM OR Possesses MMED (Internal Medicine) or MRCP(UK) AND GDFM

Yes
No

Relevant Details

DECLARATION

I hereby make an application for the Collegiate Membership of the College Programme and declare that the information stated in this application is true and correct and I have not withheld/distorted any facts. I confirm and consent to College of Family Physicians Singapore collecting, using and/or disclosing my personal data which I have provided, including the NRIC number.

Signature

Date

Please send the following:

1. Completed application form (with photograph attached) together with a cheque payment of S$5,505.34**(inclusive of 7% GST), make payable to 'College of Family Physicians Singapore'
2. A curriculum vitae
3.Certificates of your academic qualification - Med (Internal Medicine)/MRCGP(UK)/MRCP(UK) & GDFM
4. A letter of good standing from someone with MCFP(S) or above

The application, cheque payment and all required documents must be received by 7 June 2019 (Friday)

Censor-in-Chief
Collegeof Family Physicians Singapore
College of Medicine Building, 16 College Road #01-02, Singapore 169854

*Successful candidates will be provided with the use of the academic gown during the Convocation Ceremony on 23 November 2019 (Saturday). The successful candidate and one guest will also be invited to the Convocation dinner.

**Upon successfully passing the Assessment, the candidate will need to pay an additional $1,402.95 (S$374.50 (inclusive of 7% GST) Entrance fee and $1028.45 (inclusive of 7% GST) initiation fee).

FOR OFFICIAL USE ONLY

Fee Paid

Cheque / Draft No

Acknowledgement Date

Official Receipt No

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