Registration reception event Maria Middelares General Hospital

You can register for an introduction moment for trainees/students via the web form below. Pre-registration is required.

During this moment you will get to know AZ Maria Middelares and you can ask questions about the practical side of your internship.

For any questions you can contact studenten@azmmsj.be.

I am registering for the orientation event.

Status intern

Type kledij

Taal

School

Gender

Date of birth

First name

Last name

National Register Number

Enter the National Register Number as a number without dots, hyphens and spaces (11 characters). Mandatory for Belgian students.

Address details (domicile)

Address

Postal code

City

Country

Contact details

E-mail address

Preferably the email address of your school

Phone number

Picture

Add a recent photo of yourself with a neutral background here.

Education

Year of training

Medical certificate

A valid medical certificate is a strict condition to be able to start the internship in our hospital. You keep your medical certificate in your internship bundle/folder and must be able to present it at all times. Targeted checks for the presence of the certificate are provided. In the absence of this certificate, the internship will be terminated immediately.

Risk analysis

A personally signed risk analysis/workpost sheet from your internship department is a strict condition to be able to start the internship in our hospital. You keep your risk analysis/workpost sheet in your internship bundle/folder and must be able to present it at all times. Targeted checks for the presence of the document are provided. In the absence of this document, the internship will be terminated immediately.

Internship objectives

As a nursing/midwifery intern, you bring your internship goals with you to the reception and on your first internship day. The manager and/or mentor can request this. In the event of absence, the internship will be temporarily suspended.

Internship period from

Internship period until

Internship location

Choose from the list below to indicate your internship location.

If you chose 'Other' under 'Internship location', please specify below.

Clothing

Length (in cm)

Size

Remarks

Badge

If you already have a badge from a previous internship, you can register it here. If your badge is lost, you can contact us by e-mail.

Date reception moment

ATTENTION! Registrations are closed every Monday evening for the reception of that week. Register afterwards and you can follow the tour, but you will have to come back to pick up your badge.

In any case, you can only start an internship if you are administratively in order, have attended a reception moment and are in possession of your personal badge.

Confidentiality Statement – Students and Interns:

The undersigned declares to have read and approved the confidentiality statement (document in Dutch).

Read and approved

I confirm that I have taken note of the nursing and communication skills (document in Dutch).

I agree to the terms of use, privacy policy and cancellation terms.

You will receive a confirmation email after you have successfully submitted this form. Be sure to check the spam folder in your inbox.