PLACEMENTS Student Application Form

First Name *

Last Name *

Age *

16-17

18 and over

Address (Inc. Post Code) *

Phone *

Email Address *

Course *

College/University *

Year *

Are you a car driver? *

Yes

If yes, do you have a clean license?

Yes

Are you a car owner?

Yes

What is your availability?

Monday

Morning

Afternoon

Evening

Tuesday

Morning

Afternoon

Evening

Wednesday

Morning

Afternoon

Evening

Thursday

Morning

Afternoon

Evening

Friday

Morning

Afternoon

Evening

What experience do you have within the Health & Social Care sector? *

How many hours do you need to complete for the placement? *

What is your ideal start date? *

Do you have any specific learning objectives you need to achieve while on placement? *

Do you have an in date enhanced DBS check? *

Yes

Please provide the contact details of your tutor (or the placement administrator for your course) *

Thank you for completing your application for a placement within Creative Support. If you need any help with the form or have any questions, please contact the placement team at placements@creativesupport.co.uk.