Title *
First Name *
Surname *
Date of Birth (dd/mm/yyyy) *
Address *
Address 2
City *
Country *
Post Code *
Email Address *
Confirm Email Address *
Daytime telephone number *
Mobile number
Gender *
Please select
Male
Female
Rather not say
Ethnicity *
Please select
Asian British
Asian Other
Bangladeshi
Black African
Black British
Black Caribbean
Black Other
Chinese
Indian
Mixed Race
Other Ethnic Group
Pakistani
White British
White Other
I’d rather not say
Which of the following best describes your current professional role? *
Please select
Registered nurse (adult)
Registered nurse (child)
Registered nurse (mental health)
Registered nurse (learning disability)
Registered midwife
Student nurse (adult)
Student nurse (children)
Student nurse (mental health)
Student nurse (learning disability)
Student midwife
Non-practising health visitor
Non-practising midwife
Non-practising nurse
Other
If other, please specify
Where are you currently studying to be a nurse / midwife?
Please select
Aberdeen, The Robert Gordon University
Anglia Ruskin University
Bangor, University of Wales
Bedfordshire, University of
Belfast, Queen's University of
Birmingham, University of
Bournemouth University
Brighton, University of
Bristol, University of the West of England
Buckinghamshire New University
Canterbury Christ Church University
Cardiff, University of
Chester, University of
Coventry University
Cumbria, University of
Derby, University of
Dundee, Abertay University
Dundee, University of
Edge Hill University
Edinburgh, Napier University
Edinburgh, Queen Margaret University
Edinburgh, University of
Essex, University of
Glamorgan, University of
Glasgow Caledonian University
Glasgow, University of
Hatfield, University of Hertfordshire
Huddersfield, University of
Hull, University of
Keele University
Leeds Metropolitan University
Leeds, University of
Leicester, De Montfort University
Lincoln, University of
Liverpool John Moores University
Liverpool, University of
London, City University
London, King's College London
London, Kingston University
London, Middlesex University
London, South Bank University
London, University of Greenwich
Manchester Metropolitan University
Manchester, University of
Newcastle, Northumbria University
Northampton, University of
Norwich, East Anglia, University of
Open University, The
Oxford Brookes University
Plymouth, University of
Preston, University of Central Lancashire
Salford, University of
Sheffield Hallam University
Southampton, University of
Staffordshire University
Stirling, University of
Suffolk, University Campus
Surrey, University of
Swansea, University of
Teesside University
Ulster, University of
West London, University of
West of Scotland, University of
Wolverhampton, University of
Worcester, University of
Wrexham, Glyndwr University
York, University of
When do you expect to qualify as a registered nurse / midwife?
Please select
2012
2013
2014
2015 or later
Were you a registered health visitor?
Please select
Yes
No
Is your NMC registration current?
Please select
Yes
No
When did you last practice as a health visitor?
Please select
Before 1983
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Never
Type of course interested in *
Please select
Health visitor training (full-time)
Health visitor training (part-time)
Return to practice (health visiting)
Other
Preferred region to undertake course *
Please select
East Midlands
East of England
London
North East
North West
South West
South East Coast
South Central
West Midlands
Yorkshire and Humber
Who would be your preferred course provider if you decided to apply? (You are under no obligation to apply to the provider you state here – we’d simply like to know where you might like to train so we can send you the most relevant information.)
Please select
Anglia Ruskin University
Birmingham City University
Bournemouth University
Brunel University
Bucks New University
Canterbury Christchurch University
City University - London
De Montfort University
Hertfordshire University
Huddersfield University
Hull University
Keele University
Kings College London
Leeds Metropolitan University
Liverpool John Moores University
London Metropolitan University
London South Bank University
Manchester Metropolitan University
New College Durham
Northumbria University
Oxford Brookes University
Sheffield Hallam University
Teeside University
University Campus Suffolk
University of Bedfordshire
University of Bolton
University of Brighton
University of Central Lancashire
University of Chester
University of Coventry
University of Cumbria
University of Derby
University of Greenwich
University of Northampton
University of Nottingham
University of Salford
University of Sheffield
University of Southampton
University of Stafford
University of Surrey
University of the West of England
University of Wolverhampton
Which statement best describes the information you're looking for on health visiting? *
Please select
I'm looking to start a course as soon as possible
I'm reviewing my career options
I'm looking for more information on what Health Visiting is about
Where did you hear about the health visitor recruitment programme? *
Please select
Letter/mail in the post - baby-shaped mailer
Letter/mail in the post - blue/green branded mailer
Email
Magazine advert
News story
Newspaper advert
Outdoor poster
Recommended by family/friend
Career/Graduate fair
University
Hospital
Phone box poster
Other
If other, please specify
advice@nhscareers.nhs.uk.