THE ROYAL COLLEGE OF SURGEONS OF EDINBURGH

45mm
ATTACH
PART B – CLINICAL EXAMINATION PASSPORT
SIZED
Membership in Orthodontics (MOrth RCSEd) PHOTOGRAPH
HERE
DAWOUD
Last name of candidate: ………………………….…………………………………………………………………………….
35mm
(BLOCK LETTERS)

EMAN ALSAEED ALI ALSAEED DAWOUD

Other names in full: ……………………………………………………………………………………………………………..
(BLOCK LETTERS)
07/05/1995 Female
Date of birth (dd/mm/yyyy): ………………………………….… Male/Female: ……………………………………………

College username (if known): …………………………………………………………………………………………………..

Full postal address: October - Giza - Egypt

.……......…..…………………………………………………………………………………………….

…………………………….…………………………………………………………………………………………………………

…………………………….………………………………………………………………………………………………………….

00201018656599
Daytime telephone no: …………..………………………… [email protected]
E-mail: ...……………………..…..…………………………

Mobile No: …………… 00201018656599

…..……………………………….…
(Including full international dialling code for overseas trainees)

I wish to enter the PART B Membership Examination in Orthodontics (MOrth RCSEd) at the following centre

Egypt
Examination centre ……………………………Date of examination …………………………………………… 03/02/2025 to 06/02/2025
I am exempt from: Written Component (Part A)

If sitting the Part A examination directly in conjunction with a Part B Clinical diet, please indicate here:

Location:………………………………………………………Date:…………………………………………………

(This refers to a sitting of the written paper being undertaken at the same centre and on adjacent dates to the Part B Clinical

Examination you are applying for. Please contact the Examinations Section for further information if required.)

1. Please give details of your qualifications:

Qualification Awarding body Date

Bachelor degree of dentistry and

…………………………………………. …………………………………………….. ………………………………...
oral surgery that was granted by
…………………………………………. …………………………………………….. …………………………………
october 6 university july 2018
…………………………………………. …………………………………………….. …………………………………

GDC registration number: (if applicable)

…...………………………………………………………………………………

(Candidates whose names do not appear in the current UK Dentists Register must submit evidence of their
qualifications and the date of acquisition.)

2. Have you ever submitted an application for the Membership in Orthodontics of the Royal College of
Surgeons of Edinburgh? YES/NO

MORTH PART B APPLICATION (APRIL 2024) 1

 CANDIDATES MUST COMPLETE EITHER PAGE 2 OR PAGE 3
Award of the Membership in Orthodontics RCSEd (M Orth RCSEd) is dependent on evidence that the candidate will
have completed a period of three years full-time (or part-time equivalent) training in this specialty. Candidates may,
however, enter themselves for the Part B examination after two years full time training (or part-time equivalent),
provided they have the support of their Training Programme Director.

FOR CANDIDATES WITH A NATIONAL TRAINING NUMBER

If you do not have a National Training Number you should ignore this page and complete Page 3

CONSULTANT M ELKOLALY MORTH TRAINING

Title of post/course: …………………………………………………………………………

Official Hospital Stamp

NTN: ………………………………………………………………….…………………………..

01/01/2020
Dates (dd/mm/yyyy): From …………………………. To ………….…………………….. 30/06/2023
Signature of:
Training Programme Director: ………………………………………………………………

MOHAMED ABD ELAAL ELKOLALY

PRINT NAME: …………………………………………………………………………………

Date of signing (must be completed): ……………………………………………………

I certify that the above named candidate has occupied the training post above and that the outcome of the
ARCP process has been satisfactory to date:

Signature of Postgraduate Dental Dean: ………………………………………………….

MOHAMED ABD ELAAL ELKOLALY

PRINT NAME: …………………………………………………………………………………..

Date of signing (must be completed): …………………………………………………….

Please indicate the Deanery to which you are appointed by ticking the appropriate box:

Defence East of England London, Kent, Surrey &

Sussex

Midlands North East & North North West

Cumbria

South West Thames Valley & Yorkshire & Humber

Wessex

Scotland Wales Northern Ireland

MORTH PART B APPLICATION (APRIL 2024) 2

CANDIDATES WHO DID NOT COMPLETE PAGE 2 MUST COMPLETE THIS PAGE
Award of the Membership in Orthodontics RCSEd (M Orth RCSEd) is dependent on evidence that the candidate will
have completed a period of three years full-time (or part-time equivalent) training in this specialty. Candidates may,
however, enter themselves for the Part B examination after two years of full time training (or part-time equivalent),
provided they have the support of their Training Programme Director.

FOR CANDIDATES WHO HAVE OBTAINED THEIR TRAINING AT AN OVERSEAS CENTRE OR IN A UK

CENTRE BUT WITHOUT A NATIONAL TRAINING NUMBER:

Title of post/course: CONSULTANT M ELKOLALY MORTH TRAINING

…………………………………………………………………… Official Hospital Stamp

Post identifier No. (if applicable): ………………..……………………………………

01/01/2020
Dates (dd/mm/yyyy): From …………………..…………To ………..………………. 30/06/2023
Signature of
Specialist in charge of training: ………………………………………………………

MOHAMED ABD ELAAL ELKOLALY

PRINT NAME: …………………………………………………………………………….

Program Director
Position held: ……………………………………………………………………………

Date of signing (must be completed): ………………………………………………..

AND
Official Hospital Stamp

I certify that the above named has occupied a training post as

specified above and that all in-service assessments have been satisfactory:

Signature of Head of Hospital: ……………………………………………………………

MOHAMED ABD ELAAL ELKOLALY

PRINT NAME: ………………………………………………………………………………..

Date of signing (must be completed): ………………………………………………

Candidates who are unable to have the above sections signed must produce certified confirmation of the posts they
have held and attach to this form.

MORTH PART B APPLICATION (APRIL 2024) 3

3. CANDIDATE CHECKLIST

Is your application form complete?

Failure to provide the documentation listed below may result in your application form being returned

Have you included the following: YES NO

1. Complete and up-to-date contact information

2. Two recent passport sized photographs

3. Certified copy of your primary dental qualification certificate

If your name appears on the current UK Dentists Register a certified copy of your certificate is not required.

4. Evidence of 3 years full time (or part-time equivalent training)

(Candidates may apply for entry to the Examination after two years (or part-time equivalent) training, provided
they have the support of their Training Programme Director.

If you are unable to obtain the signature and stamp of your Trainer on your application form then you must
submit certificates confirming your training posts.

5. Evidence in support of the request for an exemption (if applicable)

If you are unable to obtain the signature and stamp of your Trainer on your application form then you may
submit certificates confirming your training posts.

6. Signed and dated the declaration confirming that you have read and
understood the regulations
Once the application has been received and logged, you will then be sent a link giving details of how to pay.
Copies of letters and certificates will only be accepted if they have been verified as a true copy by your
Trainer or authorised hospital official and stamped with the official hospital stamp. (The signature and
stamp must be original.) Please also note that if the official hospital stamp is not in English applicants will
be required to obtain an official English translation from a translation agency.

NOTIFICATION OF APPLICATION STATUS AND RESULT

You will automatically be kept up to date with the progress of your application by email.

Tick this box if you would like to receive updates about your application to your mobile phone via SMS

Tick this box if you would like your examination results to be sent to your mobile phone via SMS in addition to
receiving them by post*

Tick this box if you would like to receive your examination results by email*

* The College is working towards offering Examination results to candidates by email and/or SMS. We
cannot guarantee that this will be in effect by the time your Examination result is available.

CANDIDATE DECLARATION
I declare that I have read and understood the Regulations relating to the Examination for which I wish to
apply and I now confirm that to the best of my knowledge all the information given on this form is a true
statement of fact. I understand that success in this Examination will not automatically confer entry onto the
United Kingdom’s General Dental Council Specialist List. (This is dealt with by the GDC not the College).

I acknowledge that my performance in the examination may be discussed with my Training Programme
Director and Postgraduate Dental Dean/Director. (This only applies to UK candidates with an NTN).

EMAN DAWOUD
Candidate Signature: ………………………………………………………. Date: ………………………………….…
02/12/2014

MORTH PART B APPLICATION (APRIL 2024) 4

Completed Applications must be emailed to [email protected] or posted to:

Examination Section
Royal College of Surgeons of Edinburgh
Nicolson Street
Edinburgh
EH8 9DW

MORTH PART B APPLICATION (APRIL 2024) 5

EQUAL OPPORTUNITIES MONITORING

The Royal Colleges of Surgeons of Great Britain and Ireland aim to ensure fair treatment in relation to admission
and assessment of examination candidates. Completing this form will allow us to monitor our statistics and ensure
that we are delivering a fair examination to all candidates.

In line with UK and Irish legislation and good practice guidelines, we are asking all applicants to complete this section. You
are not obliged to provide any of the information in this section, but if you do so, it will enable us to monitor our business
processes and ensure that we provide equality of opportunity to all.

This information will be recorded electronically with your other data in accordance with the Data Protection Act 1998,
but used only for monitoring our business practices.

Gender
 Female
 Male Do you consider your first language to be
 Transgender English?
 Prefer not to say  Yes
 No
Ethnicity  Prefer not to say
Choose one selection from the list below to indicate
your ethnic group or background. Do you have a disability under the terms of the
Equality Act 2010? (The Equality Act defines a
a) White disabled person as someone who has a physical or
 English/Welsh/Scottish/Northern Irish/British mental impairment that has a substantial and long-
 Irish term negative effect on your ability to do normal
 Gypsy or Irish Traveller daily activities).
 Any other White background (write in)
 Yes
------------------------------------------------------  No
 Prefer not to say
b) Mixed / Multiple Ethnic Groups
 White and Black Caribbean
What is your sexual orientation?
 White and Black African
 White and Asian  Bisexual
 Any other mixed background (write in)  Heterosexual
 Lesbian or Gay
------------------------------------------------------  Prefer not to say
c) Asian or Asian British
 Bangladeshi
Marital Status
 Chinese  Single
 Indian  Married
 Pakistani  Cohabiting
 Any other Asian background (write in)  Civil partnership
 Separated/divorced
------------------------------------------------------  Widowed
d) Black / African / Caribbean / Black British  Prefer not to say
 African
 Caribbean What is your religion or belief?
 Any other Black / African / Caribbean / Black  Buddhist
British (write in)  Christian
 Hindu
------------------------------------------------------  Jewish
 Muslim
e) Other Ethnic Group
 Sikh
 Arab
 Other religion/belief
 Any other ethnic background (write in)
 No religion
-------------------------------------------------------  Prefer not to say

 Prefer not to say

MORTH PART B APPLICATION (APRIL 2024) 6