HH3215: Foundations of Practice Placement Education in Occupational Therapy

College of Health and Life Sciences

HH3215: Foundations of Practice Placement Education in Occupational Therapy

Application Form

Dear Applicant,

Please complete section 1 with the details required before passing the form to your Practice Placement Co-ordinator / Manager to complete section 2.

The format of the placement education course will now be two days preparation which will focus on the theory and practice of placement education. Following supervision of a student, participants will be able to request the opportunity to become APPLE COT accredited through the Brunel Practice Education Programme.

Section 1

Name ......
(Please Print)
Work Address (including NHS Trust, if applicable) ......
...... …………
Contact Tel No...... ……. Ext/Bleep No...... Fax No...... ………
Email …………………………………………………..
Home Address: ………………………………………………………………………………………………………………….
……………………………………………………………………………………………………………………………………..
I wish to attend the Practice Placement Educators Course on ......
Please discuss with your co-ordinator when you would be able to have a student on placement and ask them to send the offer to NHS London Placement Management Partnership (http://www.pmpartnership.org.uk/
Places on the course will only be confirmed upon a firm offer to supervise a student. Please tick below when you will supervise a student.
Placement Dates
24th October – 16th December 2016 / BSc Practice Placement 2
9th January – 3rd March 2017 / BSc Practice Placement 4
6th March – 31st March 2017 / BSc Practice Placement 1
24th April – 16th June 2017 / BSc Practice Placement 3
9th January – 3rd February 2017 / MSc Pre-Registration PPA (Level 1)
22nd May – 14th July 2017 / MSc Pre-Registration PPB (Level 2)
4th September – 27th October 2017 / MSc Pre-Registration PPC (Level 2)
24th July – 15th September 2017 / MSc Pre-Registration PPD (Level 3)
Signature ...... Date: ……………………………………………

Section 2

Name of Placement Co-ordinator / Manager ...... ………
(Please Print)
Work Address (include NHS Trust, if applicable) ......
...... ………
...... ………
Contact Tel No...... Ext/Bleep No...... Email...... ………….
I support the attendance of the above member of staff on this free course and understand that this commits our department to providing a Practice Placement for an Occupational Therapy student from Brunel University as part of the course, as indicated above.
Signature of Placement Coordinator/Manager ...... ………….

Once completed please return this form to: Ann Haddock, College of Health & Life Sciences, Mary Seacole Building, Brunel University, Uxbridge, Middlesex, UB8 3PH. Fax: 01895 269853 Tel: 01895 267612 E-mail:

G: 2016/17 Placements/PPE Courses (June 2016)