Elective placement requests for non-medical pre-registration students

Please complete all of the fields below - any incomplete application will not be accepted for consideration.

Upon receipt of your application, your request will be escalated to the appropriate team for consideration. If your chosen areas are not able to accommodate you for any reason a placement will not be offered. If an offer is made subject to clearances you will then be contacted to begin the processes of obtaining clearances to comply with Trust requirements, and your tutor or administrator will be contacted to clarify any documentation required.

Elective placement request for non-medical pre-registration students

Note: Questions marked by * are mandatory


Personal details

Course details

Placement details

Supporting information

Data protection As part of the registration process, we will collect the data submitted via this form, which we will process and hold in accordance with the General Data Protection Regulation (GDPR), in force from 25 May 2018. Please tick to indicate your consent for this data to be held and processed by us for the purpose of managing your elective placement only. We will not process your data for any other reason and will not share it with any third parties. We will hold your data on our website until a maximum of one month after submission when it will be destroyed.

*