Wirral University Teaching Hospital NHS Foundation Trust

Application Form - Information Literacy and Skills Session

Manager's Details

Manager's Name
 

Email address
 

Applicant's Details

Title
Mr Mrs Miss Ms Dr

Surname
 

First Name
 

Name Known By
 

Job title
 

Department
 

Email Address
   

I am (Please select the title/title's that apply to you)

A member of Wirral University Teaching Hospital NHS Foundation Trust (WUTH)
A member of NHS Wirral
A member of Wirral Community Trust
A member of Clatterbridge Centre for Oncology (CCO)
A student of the University of Chester
A student of the University of Liverpool
Other - please specify:

Telephone/Bleep Number
  

Session title
# Finding the Evidence Statistical Mentoring Clinic   

Session Date - please note some sessions do not have pre-scheduled dates, if a date is not offered please disregard this section of the form.

# 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / # 1 2 3 4 5 6 7 8 9 10 11 12 / 2010 2011

If you have applied to attend the Statistical mentoring clinic, please specify which appointment slot you wish you book (please refer to session outline) and provide an outline of the statistical problem or scenario in the box below.

Manager will receive confirmation e-mail confirming place. Participant will receive a confirmation email confirming their place.

I am interested in Finding the Evidence training and would like a librarian to contact me to discuss my requirements.

Please state how this session will support current role and Personal Development Plan in the box below.

Please note that failure to attend a booked place on a course may result in charges to your Division/Department. Please ensure that the participant is aware that charges will be levied to your Division/Department if they fail to attend.

Does the participant have any special requirements? If they do we will endeavour to meet their needs so that no-one need be excluded from our programmes. Please indicate below:

Disability

Learning Needs

Other