Medical Students Application Form

Please complete our application form below. All fields are mandatory as this information is required for insurance/indemnity reasons.
Copies of documents may be uploaded as images (e.g. taken by camera). All applications are reviewed by the PCP team and will be processed within 10 working days.

Username^*

Password^*

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Enter password again^*

First Name^*

Last Name^*

Date of birth^*

Gender^*

Male
Female

Mobile Number^*

This is used to contact you in case of emergency.

KCL Email Address^*

You must use your KCL email address (e.g. [email protected])

Non-KCL email^*

Term Time Address^*

KCL students intercalating at another university or external students intercalating at KCL are not able to join the KCL PCP due to insurance and indemnity reasons. I confirm that I am NOT intercalating externally or an external student.^*

Please select your year of study.^*

Please select your year of study. Unfortunately, do not currently allow intercalating students to join the PCP due to insurance/indemnity reasons.

In no more than 2-3 lines, please describe why you want to join the PCP, including any relevant experience.^*

Upload a copy of your KCL ID card^*

Upload a copy of MDU/MPS Card/Certificate^*

Please upload either your MDU/MPS card or certificate of insurance.

Please download and complete the following London Ambulance Service indemnity form. Please complete all 3 pages where indicated. Under 'Emergency Contact' please provide BOTH A NAME & PHONE NUMBER. Leave the 'call sign' and 'authorising manager' section blank.

Upload your completed Indemnity Form^*

Please download and complete the following London Ambulance Service risk assessment checklist form.

Upload your completed risk assessment checklist

We also require the details of your next of kin. This is so we can contact them in the case of an emergency or if you are involved in a road traffic collision whilst in the ambulance. It is also a requirement of the LAS for you to go on shift with them.

Name of Next of Kin^*

Relationship of Next of Kin to you^*

Next of Kin Mobile Number^*

Please provide a mobile number for your next of kin which we can use to contact them in case of emergency.

Your Indemnity form including NOK details will be accessible by all KCL PCP Paramedic mentors. It will be sent to the relevant LAS team in order to facilitate the shift.

I confirm that I have watched the LAS observer shift training video

I confirm that I have purchased KCL Emergency Medicine Society membership from the KCLSU website^*

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