British Universities & Colleges Sport

International Cover 2014

Physiotherapist Application Form

Name
Phone Number:
Email:

Please tick as appropriate (you may tick more than one or even all the boxes if you would like to be considered for any position):

EVENT DATES / TRAVEL DATES (provisional) / Tick to apply
Archery / TBC / TBC / TBC
Badminton / Córdoba (ESP) / 24-29 July / 22-30 July
Boxing / Yakutsk (RUS) / 23-28 Sept / 21-29 Sept
Cross Country / Entebbe (UGA) / 22 March / 20-23 March
Canoe Sprint / Minsk (BLR) / 15-17 August / 13-18 August
Golf / Crans Montana (SUI) / 23-27 June / 21-28 June
Karate / Bar, Montenegro / 19-22 June / 17-23 June
Orienteering / Olomouc (CZE) / 12-16 August / 10-17 August
Rowing / Gravelines (FRA) / 12-14 Sept / 10-15 Sept
Rugby 7s / Sao Jose dos Campos (BRA) / 8-10 August / 04-11 August
Shooting / Al Ain (UAE) / 8-12 October / 05-13 October
Squash / Chennai (IND) / 1-7 Sept / 29 Aug – 08 Sept
Taekwondo / Hohhot (CHN) / 8-14 June / 05-15 June
Weightlifting / Chiang Mai (THA) / 10-13 Dec / 08-14 Dec

Please note that all travel dates are subject to confirmation/ change, and all entries are contingent on NGB support and funding, and minimum entry requirements.

There is a possibility of last-minute alterations and possible cancellations that are beyond our control.

Personal statement

Referees - the names and contact details of two referees including a physiotherapist / doctor / coach or manager who currently works with you in sport should be provided

Academic Qualifications

Professional memberships and when did you become a member

Current Employment

Previous Employment

Please give details below, inc. with whom did you gain the qualification and when obtained:

ACPSM CPD level
Sports trauma/first aid qualification
Previous travel abroad with a team
Acupuncture qualification
Taping qualification
Massage qualification
Previous experience of working with student sport and HE sector
Own Kit bag (essential)
Own Plinth and Ice box (not essential)

APPLIED EXPERIENCE IN SPORT:

Example – add rows / tables as required

Event / position / How long / Where & Year / Level
BUCS Nationals, HQ physio / 4 days / Sheffield 2012 / Student - National

Multi-sport events

Event / position / How long / Where & Year / Level

Individual sport work

Event / position / How long / Where & Year / Level

Please continue or add rows as appropriate

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Please provide information of musculoskeletal / sports specific CPD undertaken in the last four years.

Date /

Activity/ Course Title

/ Hours of CPD /

Key Areas of Learning

/

Comments/ Supporting Evidence

Please continue or add rows as appropriate

Please return to:

Nicki Combarro

No later than Monday 09 December 2013

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