Professional Development Module placement plans & details form

Professional Development Module: your placement plans & details

Name*

First Name

Last Name

Student ID number*

University email address*

School*

Programme of study*

Have you ever undertaken any work-related activity in the past? (e.g. paid job, internship, volunteering)*

Yes No

Which of the following work-related activities have you undertaken in the past?

General paid work (e.g. a full-time/ part-time job) Internship (e.g. a structured summer internship programme) Work experience (e.g. work shadowing for a short period of time) Volunteering (e.g. charity fundraising)

Your placement plans

Please provide details of your placement so that we can check whether it is suitable for the module’s learning outcomes and undertake a risk assessment. Once this has been done we will contact you by email with further information.

The placement (minimum 40 hours) can take place either during the summer vacation or during term time. It can't start before June 2017 and it must be completed by the end of January 2018. Are you planning to do a summer or term-time placement?*

Summer Term-time Either (no placement confirmed yet)

If you are doing a term-time placement we will send you further details of the workshops before the start of the autumn term.

If you are or think you may be doing a summer placement, you will need to be available to attend compulsory pre-placement workshops after the main summer exams have finished and before the summer vacation, between Wednesday 7 June to Friday 9 June. The workshops will help you to prepare for both the placement and for the module’s assessments. Will you be able to attend these workshops?*

Yes No

Please explain your reasons for potentially missing these workshops. We cannot guarantee making alternative arrangments if you are unable to attend; we will contact you to discuss.*

What stage of the application process are you at?*

Please provide us with basic information on applications made (e.g. names of organisations, types of role, when you expect to hear if you are successful):*

Details about your placement

This information is required so we have a point of contact in case of an emergency. The data is held on the University of Birmingham's database and we do not normally contact the employer without discussing it with you first.

Name of placement provider (company or organisation)*

Name of lead contact at placement provider (e.g. manager)*

First Name

Last Name

Address of placement provider*

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Email address of lead contact*

Phone number of lead contact*

Your role during the placement (e.g. summer internship; volunteering project; research assistant)*

What is the expected duration of the placement? (minimum 40 hours work)*

What will you be doing during your placement? (e.g. financial analysis; work shadowing; creating a marketing survey; conducting a survey; helping develop social media)*

Have the start and end dates of the placement been confirmed?*

Yes No

Start date*

End date*

Once the dates are confirmed, please email placements@contacts.bham.ac.uk to let us know

Since the module counts towards your final degree, you need to provide evidence that your placement has been confirmed and will go ahead. If you have an email or letter from your placement provider confirming this, please upload this now. If you do not have a letter the Placements Team will contact you at a later date to request this from you.

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Other information

Is there anything else you feel we need to know?

Disclaimer, data protection, and submission

Disclaimer

We will undertake a risk assessment of your placement and may contact you following this. Once your placement has been arranged, it is essential that you work through the pre-placement checklist before commencing any placement, and take any necessary actions arising from this. The checklist is in the Placement Handbook, which is available on the module’s Canvas site. This applies both to students who have arranged their own placement and to students who have applied for a placement from the module’s bank of placements. If your placement is overseas, you should make preparations and precautiopns well in advance of your trip.

If the details supplied in this form change, you must contact us immediately via placements@contacts.bham.ac.uk

Data protection

By submitting this form, you consent to the University of Birmingham holding and processing your data for the purposes of administering the bursary for which you have registered. This data will be held and processed in accordance with the Data Protection Act 1998 and will not be retained for any longer than is necessary.

I consent to my data being held and processed by the University of Birmingham for the purposes described above.

Professional Development Module: your placement plans & details

Your placement plans

Details about your placement

Your interests

Other information

Disclaimer, data protection, and submission

Disclaimer

Data protection