PISP Application Form AT VENUE (afternoon)

Upcoming Courses

Applicant Personal Information
First Name*
Last Name*
Address*
Street Address Address Line 2 City ZIP / Postal Code
Country*
Work Email Address*
Contact Phone Number*
Contact Mobile Number*
ID Card Number*
Gender*
Date of Birth
MM slash DD slash YYYY
Age Group*
Employment Status*
Do you currently have any other disadvantages?*
Please select disadvantages*
Applicant Professional Information
Place of Work*
Department*
Profession*
Level of Education*
Are you a migrant, a person with a foreign background or part of a minority group?*
Are you a registered disabled with one of the following entities?*
With which entity are you registered?*
Kindly indicate your registration number*
Are you currently in other education or training activities?*
Select Course Dates
All modules are compulsory. Each date is limited to 20 applicants.
Module 1 - Interpersonal Skills and Professionalism in Healthcare*
Module 2 - Effective Communication with Patients & Relatives*
Module 3 - Interpersonal Skills in Patient Centred care and Conflict Resolution*
Module 4 - Managing Yourself in a Challenging Healthcare Environment (Part 1)*
Module 5 - Managing Yourself in a Challenging Healthcare Environment (Part 2)*
Module 6 - Employee-Patient/Relatives Relationships (Part 1)*
Module 7 - Employee-Patient/Relatives Relationships (Part 2)*
Module 8 - Working in Teams*
Module 9 - Team Building*
Do you require transport?*
Transport Details
Should you wish to cancel transport at any point kindly advise us 24 hours in advance. Failure to do so on two occasions will lead to forfeiture of transport provision.

Transport will pass outside your chosen location at 7am for the morning courses and at 1pm for the afternoon courses. (Transport only passes all the locations once so kindly assure that you are at your respective location on time)
Module 1 - Choose Pickup Location*
Module 2 - Choose Pickup Location*
Module 3 - Choose Pickup Location*
Module 4 - Choose Pickup Location*
Module 5 - Choose Pickup Location*
Module 6 - Choose Pickup Location*
Module 7 - Choose Pickup Location*
Module 8 - Choose Pickup Location*
Module 9 - Choose Pickup Location*
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Consent*
I agree to the privacy policy.*

Applicant Personal Information

Applicant Professional Information

Select Course Dates

Transport Details

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