Continuing Professional Development (CPD) Application Form

Personal Details

Surname: (required)

Forename(s): (required)

Title: (required)

Previous Surname/Family Name:

Date of Birth (dd/mm/yyyy): (required)

Country of Birth: (required)

Nationality: (required)

Gender: (required)

Are you currently or have you previously been registered as a student of the University of Sheffield ?

If yes then please give the following information:

Course Title:

Student Registration Number:

Contact Details

Permanent Address in the UK: (Please complete as you would expect to see on a formal document i.e. in 'Mixed-case')

Line 1: (required)

Line 2:

Line 3:

Town / City: (required)

County / Region: (required)

Country:

Postal Code: (required)

Telephone Number (including area code): (required)

Mobile Number:

We will be acknowledging your application (and sending other information) by email. Please enter the address that you most commonly use.

Email: (required)

Programme of Study - Unit Details

Please use the subject groups below to select the module you wish to study. Further modules can be negotiated after your registration has been accepted. If the module you are interested in does not appear in the drop down menu you should stop completing the form and contact the School of Nursing & Midwifery for advice (hsccpd@sheffield.ac.uk) or telephone 0114 222 2030. Your application cannot be processed if you do not select a module.

Nursing & Midwifery - Acute Care

Nursing & Midwifery - Dementia

Nursing & Midwifery - Family Planning

Nursing & Midwifery - Long Term Conditions

Nursing & Midwifery - Palliative Care

Nursing & Midwifery - Patient Saftey

Nursing & Midwifery - Professional Development

Nursing & Midwifery - Service Improvement

Human Communication Sciences

ScHARR All units taken individually are attached to the programme code HART52. Teaching for each 15 credit unit runs from the shown start date for 12 weeks with the final assessment normally being in the three week period following teaching. Please see the ScHARR pages for details of each unit.

Nursing 'Top-up' students only

If you wish to apply for a Nursing 'Top-up' course then tick the box below: Completion of NURT 77 is a pre-requesit for this application.

Honours Degree: NURT95

Marketing Information

Please can you tell us where you heard about the course that you have applied for?

Fees and Funding

In order to secure your place on a unit and register with the University of Sheffield, you must complete and return a Fees and Funding Form, which will be sent to you by e-mail after you submit this application.

Previous Education Details

Please give details of highest qualification obtained.

University / College / Institution: (required)

From (dd/mm/yyyy): (required)

To (dd/mm/yyyy): (required)

Subject: (required)

Award Type (e.g. GCSE, GCE, NVQ, BA, BSc, MA, MBChB, etc.): (required)

Duration of Course: (required)

Date of Award (mm/yyyy): (required)

Class / Score / Grade / GPA / (or Not Applicable): (required)

Employment Details

Please provide details of current employment (or NA if not applicable):

Position Held: (required)

Employer Name:

Work Telephone number at which you can be contacted (including area code):

Employer Address:

Line 1:

Line 2:

Line 3:

Town / City:

County / Region:

Postal Code:

Declaration

All decisions by the University are taken in good faith on the basis of the information you provide in your application. If we discover that you have made a false statement, or have failed to provide significant and relevant information, we are entitled to withdraw or amend our offer, according to the circumstances. You may even be required to withdraw from the degree if you have already started it. In accordance with data protection regulations, the information contained in this application will be used for the purpose of processing your application and, if you are admitted, will form the basis of your University student record. I certify that the information I have given is complete and accurate. I hereby accept and agree to observe the Charter, Statues, Ordinances and Regulations of the University of Sheffield in force at any one time.

Data Protection Act

I confirm that the personal data on this form is accurate and complete and I consent to it being processed by the University of Sheffield in accordance with its registration under the Data Protection Act 1998. I understand that this data will be used by the Higher Education Statistics Agency for statistical purposes, and by the NHS Yorkshire and The Humber and NHS East Midlands for the purposes of recording professional awards and may be passed to the Council Tax Office of the local authority, and that the University may process my data for research purposes and market research. You should be aware that the information about your enrolment, attendance and progress at this establishment may be passed to the IND of the Home Office for purposes connected with immigration. I hereby give my consent to the processing of the sensitive personal data, as defined by the Data Protection Act 1998, which I have provided separately to assist the University in monitoring its equal opportunities policy and socio-economic trends.

Check box to accept: (required)

I confirm I understand and agree with the above.

Date (dd/mm/yyyy):

If you want to print a copy of this application (for your reference only) please do so before you press the Send button.