Course apply form L2

RSPH Diploma Course

in Anatomical Pathology Technology

Application Form Level 2 Certificate - Mortuary Support

Please complete all sections 1 - 6 below - it is important that your take your time with this application. It is recommended that you read the entire application in the first instance and then collect the necessary evidence and documentation required to complete it at a later stage. You will also need to complete your organisations financial details at the end of this form - for this you will need your finance departments contact and address details.

Section 1: Details of candidate:

Gender - required by AO (RSPH):

Male

Female

Section 2: Work place mentor details:

Section 3: Candidate current employment details:

To apply for this training you MUST be working in a mortuary in a substantive or trainee position. Please provide one piece of the following supporting evidence with your details on (you are required to upload a copy with this application form). Remember only PDF or Microsoft Office documents.

Your employment supporting evidence:

Copy of your job description (with your name on)

Copy of your ID badge + front of pay slip

Copy of your employment contract

Line manager letter

Other Trust document (with your details on)

Upload employment evidence

Section 4: Candidate roles / duties

Section 5: Declarations:

The candidate:

I have read and fully understand the course requirements and eligibility criteria and commit to:

Completing the full course which will involve a time commitment of 6 days to be spread via modular online learning and examination visits as outlined in the timetable supplied.
Completing all distance learning and assessment work, set within the timeframes as required (IT or mobile device access required to be able to dial into online zoom meetings).
Completing all the assessments (exams and work based assignments) demonstrating learning outcomes have been met for final assessment by the RSPH.

The mentor:

The organisational mentor (at the organisation at which the applicant is currently employed / completing work experience) must read the following declaration.
I have read and fully understand the course requirements and eligibility criteria and commit to:

Providing a work based mentor to support the candidate, allow for the collection of work based evidence and to provide competency training to enable to candidate to meet the work based objectives.
Sharing my knowledge, skills and experience of all aspects of mortuary practice.
Countersigning any assignment evidence work submitted by the candidate verifying that work is true and accurate of any local processes and procedures.
Candidate release for the time required to participate fully in the online training and attend local examinations.

The mentor is acting on behalf of your organisation to ensure full attendance and completion of this programme.

Click here to indicate that both candidate and mentor have read the above declarations. We also consent to our information being stored for purpose (s) described in the privacy policy (view policy link in this page footer).

Section 6: Payment Options:
Payment must be provided to successfully register the candidate onto the course. Cost is £1800.00 per Candidate.

Contact in finance department to send invoice to:

Final checklist before submitting your application - have you:

Read the eligibility criteria for your course (i.e. working in a mortuary)

Scanned and attached evidence of your employment (PDF or word documents only)

An agreed work based mentor is available

PO number on your application - this is essential for the application to proceed

Payments go to North Tees Hospital:

Finance department

North Tees and Hartlepool Hospitals fT

Hardwick Rd

Hardwick

Stockton-on-Tees

TS19 8PE

accounts.payable@nth.nhs.uk

Page last updated: 06/02/24