Student Placement Record

The following information is required in order for QMU to facilitate your placement. The details that you provide may be shared with your placement team only insofar as it is necessary to do so. QMU shall at all times fully comply with and adhere to the terms of the Data Protection Act 2018 and the General Data Protection Regulation.
If you would like more information on how we control or process your data please read our Privacy Statement.

Please ensure that this form is completed no later than 4 weeks before your proposed start date.

About You

Name *

Surname *

Matriculation Number *

Programme *

Level *

Nationality *

Location of your placement *

UK
Outside UK

Passport Number

Country of Issue

If your placement is outside the UK, please ensure that you take a copy of your passport with you.

Email *

Mobile number *

Further contact details

In the case of an emergency we will need to contact someone. This is often a family member, such as a parent, or guardian, or your partner.

Family Name *

Relationship *

Contact Address *

Telephone number *

Contact Email

Your placement - please complete details of your placement

Placement Name *

Placement Contact *

Placement Address *

Placement Telephone *

Placement Email *

Placement Department *

What is the start date of your placement? *

What is your finishing date? *

Placement Hours *

Placement Wage *

If your placement is paid, your salary/agreed payment is NOT required.

If there is any other information that might impact upon your placement, please outline this in the box below:

Placement Further Info

If your placement will not be in the UK, please note the points below

Important information about your working arrangements

Many of our students come from outside the UK so we need to make you aware of the following: (UK residents are, currently, permitted to work anywhere in the European Union (EU)).

Ensure that you are allowed to work in the relevant country.
Check if a work permit is required.
Are you required to obtain Professional Indemnity Insurance?
Do you have relevant medical cover? Please note that the University will cover your medical expenses whilst on placement activities only, as detailed in our Insurance Document, available here
Do you have relevant Insurance cover?

DON’T FORGET TO TAKE A COPY OF YOUR PASSPORT WITH YOU!