University of Bristol, School of Social and Community Medicine,
Short Course Booking Request Form 2013/14
Please note, we cannot accept handwritten booking requests. Items marked with an asterisk (*) must be
completed in order for us to process your booking request.
Section 1 - Applicant Details
Title:
Forename*:
Surname*:
Job Title:
Employer or University*:
Type of work*: Please place an X in one box below
Private sector (e.g.
Pharma, consultancy)
Health service (e.g. NHS,
NICE, local authority
public health)
Education
Other
Department*:
Address*:
Postcode*:
Country*:
email*:
Telephone*:
Supervisor’s email [Bristol PhD students only]*:
Some individuals may be eligible for free or reduced price places (see our website for further details). If you
believe that you are eligible for one of these places, please complete the details below. Please note, you may
be asked for proof of affiliation.
Fee waiver. Please place an X in the appropriate
box below
50% fee reduction. Please place an X in the
appropriate boxes below
Yes
Yes
Student, Social & Community Medicine,
University of Bristol (max of 5 per person)
Other NHS staff in the Avon area†
Staff, Social & Community Medicine,
University of Bristol (max of 3 per person)
University of Bristol ACFs or ACLs not based
in SSCM.
Public health trainee in South West
Region††
University of Bristol Masters or PhD students
who are not based in SSCM.
Public Health England staff in South West
Region††
Students who reside in middle and low income
countries.
Other public health staff working in a local
authority in South West Region††
Employees of UK registered medical charities.
Other: (If you believe that you are eligible for a free or reduced price place, but do not fit into any of the
above categories, please provide details in this box)
† UHBristol; NBT; AWP; NHS Bristol, North Somerset or South Gloucestershire CCG
††
Gloucs, Somerset, Devon, Cornwall, Wiltshire.
Section 2 - Course Details
In the table below, please mark with an ‘X’ each course that you wish to book a place on.
Course Title
Cost
Days
Start date
End date
Introduction To Stata [Course Runs Three Times] 1
£400
2
17/10/2013
08/01/2014
01/05/2014
18/10/2013
09/01/2014
02/05/2014
N
Interpretation Of Infectious Disease Models
£400
2
23/10/2013
24/10/2013
N
Introduction To Economic Evaluation
£600
3
20/11/2013
22/11/2013
N
Field Epidemiology Applied to Health Protection
£600
3
04/12/2013
06/12/2013
Y
Introduction to statistical methods for
Lifecourse Epidemiology
£200
1
10/12/2013
10/12/2013
N
Analysis Of Repeated Measures
£400
2
11/12/2013
12/12/2013
Y
Systematic Reviews and Meta-Analysis
[Course Runs Twice]
£800
4
13/01/2014
09/06/2014
16/01/2014
12/06/2014
N
Basic Epidemiology
£1,000
5
20/01/2014
24/01/2014
N
Introduction To Statistics
£1,000
5
27/01/2014
31/01/2014
N
Introduction To Qualitative Research Methods
£1,000
5
10/02/2014
14/02/2014
N
Introduction To Research Governance
£400
2
24/02/2014
25/02/2014
N
Critical Appraisal Of Published Quantitative
Research
£200
1
28/02/2014
28/02/2014
N
Introduction to Network Meta-Analysis
£400
2
03/03/2014
04/03/2014
Y
Health Protection Principles And Practice
£800
4
10/03/2014
13/03/2014
Y
Applied Health Protection
£200
1
14/03/2014
14/03/2014
Y
Introduction to using conversation analysis to study
health care encounters
£300
1.5
17/03/2014
18/03/2014
N
Qualitative Research in Randomised Trials
£200
1
20/03/2014
20/03/2014
N
Basic Genetics And Genomics
£400
2
24/03/2014
25/03/2014
N
Genetic Association Studies
£400
2
26/03/2014
27/03/2014
N
Advanced Genetics And Genomics
£200
1
28/03/2014
28/03/2014
N
Questionnaire Design Application And Data
Interpretation
£600
3
02/04/2014
04/04/2014
N
Epigenetic Epidemiology
£600
3
23/04/2014
25/04/2014
N
Advanced Stata
£600
3
07/05/2014
09/05/2014
N
£1,000
5
12/05/2014
16/05/2014
Linear & Logistic Regression Models
Request a
place (X)
Section 3
required
Y
Order Course Book? (Delete As Appropriate)2
£25
Introduction To Rates And Survival Analysis
£400
2
02/06/2014
03/06/2014
Y
Advanced Survival Analysis
£400
2
04/06/2014
05/06/2014
Y
Design and analysis of RCTs
£1,000
5
16/06/2014
20/06/2014
N
Advanced epidemiological and statistical methods
£1,000
5
23/06/2014
27/06/2014
Y
Y/N
course is often over-subscribed. If you would be able to attend the course on more than one date, please write ‘1’ in the box by
your preferred date, ‘2’ in the box by your 2nd choice of date and 3 in the box by your 3rd choice of date. We will offer you a place on
your preferred date if space is available.
2 ‘Essential Medical Statistics’ Kirkwood & Sterne. Wiley Blackwell; 2nd Edition 2003 is required for this course. Please indicate 'Y'
if you wish to order a copy of this book now, the short course administrator will provide you with the book on the 1 st day of the
course. Alternatively, circle 'N' and purchase your own copy or borrow it from the library.
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Section 3 – Additional Information
Only complete this section if you are booking on one or more courses that require section 3 to be completed
(see previous page). Otherwise please move on to section 4.
Up to three most relevant Undergraduate and Postgraduate Qualifications
Year
Educational institution
Subject
Degree/diploma
1.
2.
3.
Only complete rows below relating to courses that you have applied for.
Course
Introduction to Linear
and Logistic Regression
Models
Advanced
Epidemiological and
Statistical Methods
Analysis Of Repeated
Measures
Requirements
Please outline briefly how you
meet these requirements, or how
you will meet them by the time of
the course.
Knowledge of statistical methods and their
implementation in Stata of at least the level
achieved in the 'Introduction to Statistics’
short course.
Knowledge of regression analyses and their
implementation in Stata of at least the level
achieved in the ‘Introduction to Linear and
Logistic Regression Models’ and ‘Rates and
Survival Analysis: Poisson and Cox
Regression Models’ short courses.
Knowledge of regression analyses and their
implementation in Stata of at least the level
achieved in the ‘Introduction to Linear and
Logistic Regression Models’.
Field Epidemiology
Applied to Health
Protection
Health Protection
Principles and Practice
Please briefly outline your health protection
experience.
Applied Health
Protection
Network Meta-Analysis
Introduction to Rates and
Survival Analysis
Advanced Survival
Analysis
Please provide details of your experience of
meta-analysis in Stata (to the level covered by
the course “Systematic Reviews in Health
Care: Meta-Analysis in context”), and
knowledge of statistical methods including
logistic regression (to the level of the course
Introduction to linear and logistic regression
models”).
Knowledge of regression analyses and their
implementation in Stata of at least the level
achieved in the 'Introduction to Linear and
Logistic Regression models' short course.
Knowledge of survival analyses and their
implementation in Stata of at least the level
achieved in the 'Introduction to Rates and
Survival Analysis' short course.
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Section 4 - Signature
Paying applicants: When we receive this booking request we will confirm whether there is space on the
course(s) and request payment. Booking cannot be finalised until payment is received. If we have not
received payment by ONE MONTH after your provisional booking or ONE MONTH before the course start
date(s) (whichever comes first), we may offer your place to another person on the course waiting list.
If you cancel less than TWO WEEKS before the start of a course, we are unable to offer a refund.
Applicants eligible for free places: There is a PENALTY FEE of £20 per day if you book on a course and
do not attend the full course. In fairness to others, please do not book on a course unless you are sure that you
will attend it. Please let us know TWO WEEKS before the course start date if you wish to cancel in order to
avoid the penalty fee. Please discuss all courses that you intend to apply for with your line manager /
supervisor before you book. If you cancel your place on several courses in one academic year, we will refuse
future course bookings.
Accessibility: Details about accessibility are available on the short course website.
http://www.bris.ac.uk/social-community-medicine/shortcourse/sclocation.html
If you have any special access requirements please let the short course administrator know at the time of
booking.
I wish to apply for a place on the course(s) indicated above. I have read and understood the course
fees and refund policies on this form and the course website.
http://www.bris.ac.uk/social-community-medicine/shortcourse
Please sign or type your name and date in the box below.
Name:
Date:
We collect personal details about you in order to communicate with you about the course that
you have applied for. We will not share your information with others. Once a year, we would
like to send you an email to let you know of our course dates for the forthcoming academic
year. If you do not want to receive this email, please place an X in the box to the right.
Please return this form by email attachment (short-course@bristol.ac.uk) or post to Short Course
Administrator, School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, Bristol
BS8 2PS, UK. If you have any queries, please contact the short course administrator on 01179
287247 or by email.
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