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Home
Specialties
Accommodation
Your Experience
NHS Bursary
Sign-Up
About SVG
About Us
- Why Us
Contact Us

Thank you for Signing Up

To complete the Enrolment, please fill out the form below

Thank you for choosing Caribbean Electives Abroad to be a part of your education journey. We are excited to begin preparing for your arrival. Please complete our enrolment form to confirm your placement and secure your spot. Our simple and secure enrolment form ensures you can start your unforgettable Caribbean elective experience with ease. If you have any questions, our team is here to help every step of the way.

For any questions you might have, contact us here and our team will be happy to assist you.

Enrolment Form

Booking ID Number(Required)

Please enter your Booking ID number sent to you with the Sign-Up Confirmation Email. If you do not have it, no worries, please email us at [email protected]. Include your name and telephone number and we will resend your Booking ID Number.

Personal Information

Name as stated in passport(Required)

First Name Last Name

Date of Birth (D.O.B.)(Required)

Day

Month

Year

Gender

Nationality(Required)

Passport Number(Required)

Passport Expiry Date(Required)

Mobile(Required)

E-Mail(Required)

Preferred Elective Specialties

1)First Specialty(Required)

2)Second Specialty(Required)

3)Third Specialty(Required)

How many days are you required to go to the clinic during your elective?

Please be aware that clinic availability is subject to change and is at the discretion of the physicians

Untitled

Health Fairs

Medical education forum in schools

Medical education forum with sports teams

Dinner or drinks with Medical Professional

Social Mixer with American Medical students

Address (for correspondence)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Emergency Medical Information

Medical Conditions

Medication

Allergies

Type of Reaction

Emergency Contact Details

Emergency Contact Details(Required)

Emergency Contact - First Name Emergency Contact - Last Name

Emergency Contact Details

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship(Required)

Emergency Contact Email(Required)

Emergency Contact Mobile(Required)

Emergency Contact Landline

Travel Companions

Are you traveling with others?

Yes

If yes please list your travel companions.

University Information

University Name(Required)

Year of Medical School(Required)

Your School's Elective Period Start Date

MM slash DD slash YYYY

Your School's Elective Period End Date

MM slash DD slash YYYY

Your School's Deadline date to Sign up for an Elective

MM slash DD slash YYYY

University Electives Director

Yes

Does your university have a elective director or person in charge of elective placement coordination for students?

Electives Director Contact Details

Director - First Name Director - Last name

Electives Director Salutation

Electives Director Email

Electives Director Mobile

NHS Bursary Refund

Are you eligible for the NHS Bursary Refund?

Yes

Would you like helping filling out the application for the NHS Bursary Refund?

Yes

In the interim please check out our NHS Bursary Help Page to get familiar with the form and the process.

Referrals

How did you hear about us? (Check all that apply)

Social Media

Search Engine (google, bing,etc.)

Through a friend/colleague

Referral (state name)

Referral - Other (please specify)

Additional Requests

Please inform us on additional ways we can accommodate you.

Payment and Accomodation Deposit Information

Please note that after paying the Placement Deposit, full payments must be made 12 weeks (3 months) prior to your elective start date. Additionally, an Accomodation Security Deposit of £175 will be billed separately before your elective start date. This deposit will be refunded to you at the end of the elective, subject to an inspection.

Signature(Required)

By signing below you are agreeing to all of the Caribbean Elective Abroad terms and conditions, as stated on our website, and that all of the information above is correct.

Consent(Required)

I agree to the terms & conditions.

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Home
Accommodation
Your Experience
NHS Bursary
Sign-Up
About SVG
About Us
Contact Us

Home
Accommodation
Your Experience
NHS Bursary
Sign-Up
About SVG
About Us
Contact Us

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