Resus and Simulation Course Application

Get in touch:

If you have any queries or problems with your application, please contact the team:

Email: resuscitation.admin@lthtr.nhs.uk
Telephone: 01772 524839

"*" indicates required fields

Name*

Prefix First Last

Preferred badge name*

Primary Contact Number*

Alternative Contact Number

Email*

Indicate your profession*

Are you a Doctor/Internal Health Professional (ie. Nurses, AHP), LTHTr Foundation Doctor or External Candidate?

Healthcare Professional Registration Number*

ie. GMC / NMC / HPC

Grade*

Speciality*

National Training Number*

Name of the Trust you are returning to*

If you are not returning to work and are renewing your certificate or a new starter, please enter N/A

Return to work date*

If you are not returning to work and are renewing your certificate or a new starter, please enter N/A

Length of time out of training*

If you are not returning to work and are renewing your certificate or a new starter, please select NA

Reason for time out of training*

If you are not returning to work and are renewing your certificate or a new starter, please select NA

Are you returning to a patient facing role?*

If you are not returning to work and are renewing your certificate or a new starter, please select NA

Is this your first NHS role?*

What is your manager's name?*

What is your manager's email address?*

Please specify any dietary/other requirements for face-to-face training*

If you require any additional support or alternative access on the day, please specify what you will need and a member of the team will contact you to discuss.

Select the course that you wish to attend*

Select the date that you wish to attend*

Postal Address*

Please enter the postal address you would like your course materials to be mailed to

Street Address Address Line 2 City County Post Code Country

Work Address*

Please enter your work address that you are currently employed at

Street Address Address Line 2 City County Post Code Country

How did you hear about this course?*

How do you intend to pay?*

Please indicate if you are receiving any funding for this course and confirm how you wish to pay. Once your application is submitted, a member of the team will be in contact via the email given above to take payment.

Do you require a car parking space?*

What is your registration number?*

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