A PHP Error was encountered

Severity: Warning

Message: Undefined array key "course"

Filename: controllers/Admin.php

Line Number: 288

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 288
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: Undefined array key "availability"

Filename: controllers/Admin.php

Line Number: 289

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 289
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: Undefined array key "course_session"

Filename: controllers/Admin.php

Line Number: 290

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 290
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: Undefined array key 0

Filename: controllers/Admin.php

Line Number: 293

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 293
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: Trying to access array offset on value of type null

Filename: controllers/Admin.php

Line Number: 293

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 293
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: Undefined array key 0

Filename: controllers/Admin.php

Line Number: 294

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 294
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

A PHP Error was encountered

Severity: Warning

Message: Trying to access array offset on value of type null

Filename: controllers/Admin.php

Line Number: 294

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 294
Function: _error_handler

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

Centre for Health Education
Course Application Form

A PHP Error was encountered

Severity: Warning

Message: Cannot modify header information - headers already sent by (output started at /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/system/core/Exceptions.php:271)

Filename: views/eals_application_form.php

Line Number: 105

Backtrace:

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/views/eals_application_form.php
Line: 105
Function: header

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/application/controllers/Admin.php
Line: 344
Function: view

File: /var/www/vhosts/clinical-training.co.uk/httpdocs/pt_ci/index.php
Line: 315
Function: require_once

(All * marks are mandatory)

 
 


Full name (this is how you wish your name to appear on your course certificate)

Title *
Forename(s) *
Surname *


Name that you are known/called by (this will go on your ID Badge)

Name *


Personal Details

Address Line 1 *
Address Line 2
Address Line 3
Town / City *
Postcode *
Country *
Mobile Number *
Work Number
Ext-Bleep Ext: Bleep:
Email *
Special Physical Needs * [Type No, if you have no special needs]
Special Dietary Needs * [i.e. Gluten free, Any allergy, Halal, No Beef, No Pork etc.
Type No, if you have no special dietary
needs]
[Dietary needs only applicable in face to face courses.]


Professional Details

(please choose Not Applicable for any section that is not appropriate for you)

Job Title *
Speciality *
GMC/NMC/HPC Number
(UK applicants only) *
[Type N/A if you don't have any of these number]
Which NHS Health Board or NHS Trust do you work in?*
Name of Hospital or Institution *
Address of Hospital or Institution *
Address Line 1*
Address Line 2
Address Line 3
Town/City*
Country*
Postcode*


Username/Password (For Member Login)

Email(same as above)*
Password * [Minimum character 8, maximum 12, NO special character (&,!,$,%,...) Please]


Photo Upload (For Course Administration)

Please upload a recent photo of yourself. *
[Please ensure that the photo you are uploading is named in the following format: 'firstname_surname', e.g. if your name is David Jones then name your photo file as David_Jones.jpg, before uploading it. We accept photo files of any of the following formats: gif, jpeg, jpg, pjpeg, x-png, png.]


Course Details

Please select your course
Your selected session


Potential Instructorship

If you do well at the course, would you like to be considered for instructorship?


Course Payment

Are you paying your course fee/administration fee by yourself or is any other trust/organization paying on your behalf? [If you are normally funded by your Health Board, you will need to initially pay the fee yourself, then re-claim the cost from the Health-Board]

Please specify:
(e.g. Self / Health Board etc..)

Disclaimer: Any interaction with your Health Board or responsibility for claiming funding support lies solely with you, the candidate, and not with the course organiser.

View our Privacy Policy*
*(Click to Download)

(Click to confirm you have read the Privacy Policy)

View our Terms & Conditions*
*(Click to Download)

(Click to confirm you have read the Terms and Conditions)

 

PLEASE NOTE: YOU WILL ONLY BE ABLE TO ACCESS YOUR ACCOUNT ONCE YOUR APPLICATION HAS BEEN APPROVED.