Dental Hygiene And Dental Therapy. Application Form For Entry In April Please refer to our Application Guide before completing.

Transcription

1 School Of Clinical Dentistry. Dental Hygiene And Dental Therapy. Application Fm F Entry In April Please refer to our Application Guide befe completing. F Office Use Only Received App No. A: Personal details Surname: Fenames: Title: Previous surname: of birth: Age on 15 April 2019: Gender: Male Female Have you applied befe? Yes No Country of birth: Do you have settled status in the UK? Yes No Fee status: Home (UK/EU) Overseas If yes, f what year? Nationality: No. of years in UK: It is your responsibility to clarify your fee status and indicate this. The Admissions Service will subsequently undertake a fee status assessment once you have been offered a place. Visit our website to find out me about your fee status. B: Contact details Address: City: Country: Tel: County: Postcode: Mobile: Please notify us of any change of address as soon as possible, to ensure that any crespondence reaches you. C: Criminal convictions Do you have any criminal convictions? Yes No This includes any ongoing investigations, spent convictions, cautions, verbal cautions and bind-over ders. D: Employment histy Please give details of your most recent employment in date der. Name and address of employer Nature of wk From To FT/PT E: Education Please give details of the most recent secondary school/college/university you have attended in date der. From To Name and address of school, college university FT/PT

2 F: s completed Please enter details of all examinations assessments f which results are known including those failed in date der. Please enclose transcripts f BTECs, Access to HE courses, degrees overseas qualifications. G: s to be completed results pending Please enter details of all examinations assessments f which results are pending. Please remember to contact us when you receive your results f these qualifications. H: English language Please state your first language: Please list any English language qualifications you have (GCSE, IELTS etc). Overall /sce of award () If you haven t got an English language qualification but you re going to take one in the near future, tell us about it below. Expected date of test ()

3 I: Suppting statements Please supply answers f each of the four questions in the spaces below in suppt of your application. Each section should be between 150 and 200 wds long. Refer to the Application Guide befe completing. i. Why do you want to be a dental hygienist/therapist? Why do you think you will make a good dental hygienist/therapist? Include details of any relevant wk experience in your answer. ii. Why is good communication imptant in dentistry? Give an example of where you have used your communication skills to deal with a difficult situation.

4 I: Suppting statements continued iii. What does professionalism mean to you? Give an example of where you have acted with integrity. iv. Why is teamwk imptant to dentistry? Give an example of where you have demonstrated effective team wking.

5 J: Widening Participation Scheme Have you participated in a Widening Participation Scheme (e.g. ADOPT)? Yes No Go to section K If yes, please give details: Name of scheme From () To () K: Reference Please include a reference (on headed paper) with your application. It should be signed and then sealed (with another signature across seal) by your referee. Your referee should be a recent employer/tut who can comment on your character and suitability f the programme and profession. In the space below give details of your referee. Name: Address: City: Country: Tel: How long have you known the referee: Title: County: Postcode: In what capacity: L: Disability details If you have a disability, it s imptant to let us know so we can make sure you get the suppt you need. This infmation is not used by academic staff when they consider your application. Please tick the most appropriate box f you. D000 No known disability D080 Two me disabilities D510 A specific learning difficulty such as dyslexia, dyspraxia AD(H)D D530 D540 A social/communication impairment such as Asperger's syndrome/other autistic spectrum disder A long standing illness health condition such as cancer, HIV, diabetes, chronic heart disease, epilepsy D550 A mental health condition, such as depression, schizophrenia anxiety disder D560 A physical impairment mobility issues, such as difficulty using arms using a wheelchair crutches D570 Deaf a serious hearing impairment D580 Blind a serious visual impairment uncrected by glasses D960 A disability, impairment medical condition that is not listed above D990 Not known If you have a disability, do you have any related suppt needs? Yes No If yes, please give details here:

6 L: Checklist Please use the list below to check your application is complete and ready to be submitted. Yes Referred to the Application Guide befe completing the application fm Yes All sections of the application fm completed Yes NA Transcript enclosed f BTECs, Access to HE courses, degrees international qualifications Yes Reference enclosed (signed and sealed with signature across seal) Yes Declaration signed Yes Equal opptunities fm completed Yes NA Stamped addressed envelope enclosed (to receive confirmation of receipt of application) Yes Crect postage used (accding to size and weight) M: Declaration All decisions by the University are taken in good faith on the basis of the infmation you provide in your application fm. If we discover that you have made a false statement, have failed to provide significant relevant infmation, we are entitled to withdraw amend our offer, accding to the circumstances. You may even be required to withdraw from the course if you have already started it. In accdance with data protection regulations, the infmation contained in this application will be used f the purpose of processing your application and, if you are admitted, will fm the basis of your University student recd. I certify that the infmation I have given is complete and accurate. Signed: : Deadline f receipt of completed application fms (including reference): Friday 28 September Unftunately, if your application fm is received after this date it will not be processed. It is in your best interests to submit your application as earlier as possible. This will enable us to clarify any details necessary to assess your application. Please return completed applications to: Dental Hygiene and Dental Therapy Office School of Clinical Dentistry University of Sheffield Claremont Crescent Sheffield S10 2TA Thank you f applying to our course. We look fward to reading your application.

7 School Of Clinical Dentistry. Dental Hygiene And Dental Therapy. Equal Opptunities Fm. This infmation is treated confidentially. It is not passed on to the academic staff considering your application. We use it to keep track of the number of students joining us from each ethnic group. This helps us promote equality and diversity. F details of our equal opptunities policy, visit our website: Equal opptunities Please tick the term you feel describes your ethnic igin and return this fm along with your application. If none of the terms seem appropriate, tick box 80. If you want to withhold this infmation, tick box 98. White (10) Black Black British Caribbean (21) Black Black British African (22) Black other background (29) Asian Asian British Indian (31) Asian Asian British Pakistani (32) Asian Asian British Bangladeshi (33) Asian Asian British Chinese (34) Asian other background (39) Mixed White and Black Caribbean (41) Mixed White and Black African (42) Mixed White and Asian (43) Mixed other background (49) Other ethnic background (80) Infmation withheld (98)