PLACEMENTS Student Application Form

First Name *

Last Name *

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.