University Hospitals Birmingham NHS Foundation Trust

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Apply to the Research to Publication programme

Please note this form will need to be completed in one sitting - you cannot save it and return to it later. Therefore, we suggest you draft your answers to the questions in the "supporting information" section separately, such as in a Word document, until you are ready to copy them into the form and submit it. Should any problems occur, you will then still have your drafted answers and won't have to type it all out again.

Personal details

Current employment

Please provide some details about your current employment.

Professional and academic qualifications

Please enter details of qualifications held in chronological order from the most recent to the oldest. If you run out of space, please enter details of any other qualifications in the "additional qualifications" field at the end of the section.

Supporting information

Supporting statement from employer

Please note your line manager/organisational designate with authority will need to agree to the following. Please check the relevant boxes to indicate their agreement. We may need to contact them to confirm this information.

The information you have provided will be used to process your application for the programme and will be used in the administration of the programme should you be successful.

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