Student clinical application form

Name of College: *

Name of course: *

Current year of course (e.g. Yr 1): *

Month/Year due to graduate: *

Select one... JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

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Name of Supervisor:

Do you have any nursing/medical or midwifery qualifications (e.g. RGN)

Declaration: I apply for Student Clinical Membership on the basis that I am a student at a Society recognised course undertaking the clinical training component of that course in the UK, and my supervisor has been approved by my course provider. I understand I will need to move on to Registered Membership on completing my homeopathic training.

I agree to abide by the Society's Code of Ethics and Practice and will not utilise the name, goodwill or facilities of The Society for monetary gain, to enhance personal reputation, to solicit patients or to obtain personal benefit.

I understand that I will not be entitled to indicate my Student Clinical Membership by any form of title or initials.

Click to confirm that you have read and accept the above declaration. *