First name Last name Email Placement choices If possible please provide additional choices. Unfortunately we can not always guarantee a place on your first choice placement. First choice Second choice Third choice Current education I am currently studying Course name Current year 1st 2nd 3rd 4th 5th 6th Our placements are open to those with little practical experience, however, applicants should be able to demonstrate how participation will benefit their current studies, build on previous experience and contribute to their own career ambitions. Please explain this below. Why would you like to participate on a Grampus Heritage work placement, in particular, how the placement links with, and will benefit, your current studies. Age verification & parent/guardian details I am under 18 years old Please provide your parent or guardian details First name Last name Email Special Educational Needs and Disabilities (SEND) Yes If successful we will discuss any specific requirements you will need to help you on your placement. Medical information Have you been, or are currently being, treated for problems related to the use of drugs/alcohol? Yes No Do you have any physical impairment that would limit the amount or type of physical work that may be assigned to you? Yes No Please list any medical conditions that you have or have had in the past. Yes No Do you need medication or medicine for any reason? Yes No Do you have any allergies? Yes No Do you have any learning difficulties and/or disabilities? Yes No Do you require any additional support linked to your disability? Yes No I confirm that I am currently residing in the United Kingdom and that my information will be processed as set out in the privacy policy and terms & conditions in order to be accepted on a work experience placement. Please note that places are allocated on a first come first serve basis so your first choice may not always be available. Submit Application
