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Student Application to participa

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					Student Application Form
_______________________________

Personal Information (please complete in block capitals):

Surname:…………………………………………                  First Name: …………………………………………….

University Identification/Registration Number:……………………………………………………...

Current Year of Study:……………………………………………………………………………………………….

Degree Programme:……………………………………………………………………………………………………

Name of Personal tutor:……………………………………………………………………………………………..

Term-time address              Home address:
……………………………………………………………        ………………………………………………………………..
……………………………………………………………        ………………………………………………………………..
……………………………………………………………        ………………………………………………………………..
Term-time tel no:………………………………  Home tel no…………………………………………..
Mobile number: …………………………………………………………….
Email address: …………………………………………………………….

Questions to assist in finding you the right placement

Which days of the week, and times of the week are you NOT available?
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….

Are you able to travel independently (either by private or public transport. Please
indicate if you have access to a car while at university)?
…………………………………………………………………………………………………………………………………….

Do you need any special arrangements in order to undertake a placement?
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….

Are you a member of, or strongly affiliated with, a political party (you do not have
to answer this question, but it may bar you from a placement with a party
political actor who requires a student sympathetic to the party in question)?
……………………………………………………………………………………………………………………………………
…………………………………………………………………………………………………………………………………….
Is there any other information that we should know when deciding on the best
placement for you?
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….
…………………………………………………………………………………………………………………………………….



References

Please provide the name and contact details of two referees – at least one referee
should be familiar with your university studies.

Name:…………………………………..…………….… Name:………………………..……………………………

Address:…………………………………..……….….. Address:…………….……………………………………

Tel No:…………………………………………………..             Tel No:…………….………………………………………

Email:………………………………………………..….. Email:………..……………………………………………
In the space provided below, please address the following in 450-500
words:
i. Why are you applying to undertake a placement as part of your studies?
ii. How do you think the placement experience will benefit your academic studies?
iii. What do you expect to gain from the placement personally?
Signed                                              Date

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

(Email submission of this form will be taken as proof of signature.)



All information provided on this application form will be treated in the strictest confidence.

				
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posted:5/13/2010
language:English
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