Return to Practice Preparatory Interview Form

Thank you for your application for the Return to Practice Programme and you have now been selected to attend an Admissions Day. Prior to your attendance for the Admissions Day the tutors require you to complete the following form, in full, to the best of your knowledge. Once you have submitted the form it will be emailed to the tutors directly for them to assess prior to meeting you.

We recommend you complete the form in as soon as possible but at least a week prior to your Admissions Day in case the tutors need to contact you regarding any of the information provided. The information you share here will form the basis of your interview when you attend the RTP Admission Day.

Name*

First Last

Address*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Email address*

Enter Email Confirm Email

Phone number*

Before commencing your return to nursing practice, it will be important for you to carry out a self-assessment, noting your strengths and areas for development. The following questions have been designed to help you to start this process. Please complete these prior to the Admissions Day.

What has made you want to return to practice now?*

What qualities, skills or experience can you bring back into nursing following your break in practice?*

Admission clearances

NMC details and registration status:

NMC Pin*

NMC Status

Do you have any NMC restrictions or conditions of practice?*

Yes

No

Please be prepared for further discussion at interview regarding NMC and DBS information.

It is not expected that you will have any existing links to practice. However, if you have contact with any potential placement areas please add the details:

Please give details on placement, notes and contacts

Comments

This field is for validation purposes and should be left unchanged.

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Return to Practice Preparatory Interview Form