Registration Specialist Exam

Title*

Name*

First name*

Institution

Department

Street*

Zip Code*

City*

Email (private)*

Mobile*

Date of birth*

GLN*

Postgraduate education*

(please list only the specialist education here, i.e. without internal medicine)

The specialist postgraduate education covers the following areas: oncology, hematology, radio-oncology/radiotherapy, pediatric oncology/hematology, pathology, palliative medicine, oncological research (see postgraduate education program in medical oncology, Art. 2.1.3)

For a change in workload within the same training center, please use a new line.

From (MM/YY)	to (MM/YY)	Workload (%)	Institution of postgraduate education	File upload

Absences

I was absent for more than eight weeks during a year of postgraduate education through no fault of my own (illness, pregnancy, military service; see Regulations on Further Education, Art. 31

Yes (please indicate which periode)

Preferred language of exam (will be considered if possible)

German

french

italian

I hereby confirm that the information I have provided is correct and complete*

I have read the privacy policy and agree to my data being used within its framework*

* indicates a mandatory field

Problems filling out the form? Please contact info@sgmo.ch or +41 (0)43 266 99 12 (during business hours)