Likewise placement application form
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Email *
Likewise Placements
Which Likewise placement opportunity are you applying for? *
What is the required length of your placement? *
Please check your university's requirement for this. For example: 75 days, 210 days, 30 weeks
Proposed start date *
Proposed end date *
Proposed days/hours per week *
Have you made sure your proposed dates/hours meet the required length of your university placement, as well as our minimum requirements for your type of placement? *
University/Course Provider details
Name of university/course provider *
Course *
University/Placement contact *
University/Placement contact email *
Further details about your placement
What requirements do you need to meet whilst on placement with us? Please give us much information as possible about type of work you're expected to undertake, length of placement, supervision, assessments, meetings with the university, reporting, etc. Please note that only our creative therapy placements are clinical, so if you are looking for a clinical placement this may not be suitable. *
Why do you want to undertake a placement with Likewise in particular? Treat this as your cover letter - this an opportunity to tell us why you really want to be part of our placement programme. Write as much as you feel you need to to get across your message! *
Personal details
Forename(s) *
Surname *
Preferred Pronouns *
Preferred name *
Home address (including postcode) *
Borough *
Primary telephone number *
Alternative telephone number
At Likewise we're committed to equality and diversity.

Respecting and valuing differences will ensure that our policies and services reflect the needs and experiences of all who access Likewise. We will only succeed if we value the people who work with us, invest in their development and create an inclusive culture.
Age *
Gender/Gender identity *
Sexual Orientation *
Ethnicity *
If you answered 'Other', please specify provide more information
Religion *
Emergency Contact details
Please provide details of someone to contact in the event of an emergency
Name *
Relationship to student *
Primary telephone number *
Alternative telephone number
Health
Are there any medical conditions we should know about in the case of an emergency? *
If 'Yes', please provide details:
Role requirements and reasonable adjustments
Are there any tasks/activities that would ordinarily be undertaken on this placement that you feel you would be unable to participate in on the grounds of disability or religion? If so, please provide a bit of information around this.
Please read our privacy policy & tick here to indicate that you agree for your information to be used in this way. https://likewise.org.uk/privacy/ *
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