Application For Higher Education Programme Admission

Please complete in black ink or electronically as it may need to be photocopied.

Surname:Gender: Male Female

Forenames (in full): Country of permanent residence:

Date of birth (dd/mm/yyyy): Nationality:

Address(es) Permanent address: Address for correspondence:

Postcode: Postcode:

Phone: Phone:

Email: Email:

Details of course applied for

Course title (please tick as appropriate):

FdSc Hospital Engineering FdSc Medical Equipment Technologies BSc (Hons) Management of Healthcare Engineering Technologies and Facilities

Start month (please tick as appropriate): April October

Source of finance Method of fee payment (please tick as appropriate):

Employer-funded Student loan Self-funded Other:…………………………………………………………………..

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Application For Higher Education Programme Admission

Current professional qualifications (in order, starting with the most recent)

Place of study

(institution, country)

Qualification titleLevel

(e.g. HND,A-level)

Gradeachieved

Dateawarded

Employer details Organisation’s name:

Line manager’s name:

Line manager’s job title:

Line manager’s telephone number:

Line manager’s email address:

Please state the opportunities you will have to undertake the practical activities and assessments you are required to carry out in your workplace:

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Application For Higher Education Programme Admission

Personal statement

Please see guidance notes below.

Continue on a separate sheet, if necessary.

Guidance notesPlease supply further information in support of your application. This should include your reasons for applying for the course, your academic interests and career aspirations. You may also wish to include the skills and experience you have gained from previous experience, placement or voluntary work, particularly if it is relevant to the subject. Award leaders will read personal statements to determine your suitability for the course for which you have applied. It is particularly important therefore that you include all information that you feel will support your application.

You may also wish to visit www.ucas.com for further guidance in writing your personal statement.

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Application For Higher Education Programme Admission

General information Please state where/how you heard about the course you are applying for, giving the names of any publications/websites if possible:

Disability / additional support

Please detail any disabilities/additional support, including learning support, that may require special facilities or consideration:

Applicant declaration

I confirm that to the best of my knowledge, the information given on this form is correct. If accepted for the programme of study, I agree to comply with all university regulations and procedures.

Applicant signature (an electronic signature is acceptable): Date:

Employer/ Manager declaration

I confirm I am aware of the scope of this educational programme, and agree to support the member of staff with associated workplace study activities within the reasonable bounds of organisational controls on security, confidentiality and safety.

Employer name:

Employer signature (an electronic signature is acceptable): Date:

Return completed forms to: Higher Education Programmes Coordinator, Eastwood Park Training, Falfield, Wotton-under-Edge, Gloucestershire, GL12 8DA, or foundationdegree@eastwoodpark.co.uk .

You will be informed of the result of your application and what you need to do next.

Eastwood Park will ensure that all information held about you will be dealt with confidentially, held securely and only processed in accordance with Eastwood Park’s Data Protection Policy.

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(For Office Use Only)

Accepted/Declined: Signautre: Date:

The course you are applying for is an online distance learning programme. Key teaching and assessment sessions will be delivered during 4 mandatory residential study weekends throughout each year of the course, which is further supported by on-line (distance learning) materials that will underpin learning.

You will need to have access to the internet, be able to upload and download files, be able to send and receive email and use a Word and spreadsheet programme. You’ll also need to be able to download and install lab simulation software.