Experienced Clinical Educators’ Update Course
Application Form
I wish to attend on:
Time:
Venue:
Your Name:
Date:
Work Address:
Job Title (and Band):
Speciality:
Daytime Phone No:
Mobile Phone No:
Email Address:
From which University does
your workplace currently
take students?
Please email your completed form, in WORD format, to:
Eileen.Evans@nottingham.ac.uk
You will then be notified of whether or not you have secured a place.
You must return this form in order to be considered for a place on the
course