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• NHS Athens for Student Placement Request

NHS Athens for Student Placement

Application for NHS Athens username / password:

  ** You must be a student on placement at a North Staffs NHS organisation.

  ** The username is only to cover your placement period.

  ** You must abide by the terms and conditions.

  ** You must enter all the information requested here, in the correct format. Failure to do so may result in this application being rejected.

  ** By using this online form you agree to allow us to check your library record for the relevant details we need to set up the account.

  ** It may take up to 3 weeks before this form is processed, depending on workloads.

  ** You will be notified via an automatic email when your username has been created.

  ** If you do not wish to complete this online form you can apply by completing a paper form available from the Health Library counter.

Your Details:
Title:*
First Name:*		Last Name:*
Please select the NHS Organisation where you will be on placement
NHS Organisation:*	Select your organisation Combined Healthcare NHS Trust North Staffs Clinical Commissioning Group Staffordshire and Stoke-on-Trent Partnership Trust Stoke on Trent Clinical Commissioning Group Stoke Public Health University Hospital of North Staffordshire Other
University or College:*	Select your organisation Keele University Other	Enter Other:
Users must enter their university/college email address
Email:*
Library Card No:*
Placement start date:*		Placement End Date:*

*Denotes a mandatory field