Register of interest form

Please complete all necessary fields within this form.

Vocational Details

* Vocational area applied for:

* Name

* Job Title

* Department

College or Training Organisation

* Address

* Tel number

* Email

Line Manager Details

* Line Manager Name

* Line Manager Tel Number

* Line Manager Email

Qualifications

* Qualifications

* Length of teaching service

* Subjects taught and level/Management function (as appropriate)

* Staff development undertaken in the past 3 years

* Any previous industrial experience, with dates

* Prioritise the aspect of your vocational area that you would like to focus on within industry:

* How did you and the college or training organisation identify the need for a placement in industry?

* What are the proposed benefits of the experience to you, your students and your college or training organisation?

* Outline any industry links you may have already established with regard to a placement

Nominated placement company (if known)

Proposed placement dates (if known)

* Please tick this box to confirm that your Director and Senior management team are aware of this application

After submitting this form please email Maggie Robinson with a supporting statement from your line manager. This should focus on:

How will this Lecturers into Industry placement activity support your college development plan?
How will the proposed activity benefit your department in general?
How do you anticipate supporting the member of staff, before, during and after the placement?

You cannot Save this form but after you submit it an electronic copy will be sent to you (which you can print).

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