Nursing Students Application Form

Please complete our application form below. All fields are mandatory as this information is required for insurance/indemnity reasons.
Copies of documents may be uploaded as images (e.g. taken by camera). All applications are reviewed by the PCP team and will be processed within 10 working days.

Username^*

Password^*

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Enter password again^*

First Name^*

Last Name^*

Date of birth

Gender^*

Male
Female

Mobile Number^*

This is used to contact you in case of emergency.

KCL Email Address^*

You must use your KCL email address (e.g. [email protected])

Non-KCL email^*

Term Time Address^*

Please select your course.^*

Which area of nursing are you training in?^*

Please select your year of study.^*

In no more than 2-3 lines, please describe why you want to join the PCP, including any relevant experience.^*

Upload a copy of your KCL ID card^*

Upload a copy of your RCN card^*

Please upload a copy of your RCN card

Please download and complete the following London Ambulance Service indemnity form. Please complete all 3 pages where indicated. Under 'Emergency Contact' please provide BOTH A NAME & PHONE NUMBER. Leave the 'call sign' and 'authorising manager' section blank.

Upload your completed Indemnity Form^*

Please download and complete the following London Ambulance Service risk assessment checklist form.

Upload your completed risk assessment checklist

We also require the details of your next of kin. This is so we can contact them in the case of an emergency or if you are involved in a road traffic collision whilst in the ambulance. It is also a requirement of the LAS for you to go on shift with them.

Name of Next of Kin^*

Relationship of Next of Kin to you^*

Next of Kin Mobile Number^*

Your Indemnity form, including NOK details, will be accessible to all KCL PCP Paramedic mentors. It will be sent to the relevant LAS team in order to facilitate the shift. Please ensure these details are accurate as shifts will not be approved without them.

I consent to all data shared in this registration being shared with the relevant PCP and LAS teams/team members.^*

I consent.
I do not consent.

PCP applications can not be approved without consent to share this data with the aforementioned teams. Please email [email protected] if you have any queries.

I confirm that I have watched the LAS observer shift training video <label><label></label> *</label>

I confirm that I have purchased KCL Emergency Medicine Society membership from the KCLSU website^*

Nursing students are required to submit their ongoing achievement record (OAR) pages from each placement they have completed. I.e. Nursing students at the end of 2st year will be required to submit 6 OARs, students at the start of their programmes will have no OARs to submit etc. This is a requirement from the nursing school and is not controlled by the PCP team. Any OAR issues will be considered on a case-by-case basis. Please feel free to get in touch with the PCP team if you have any concerns or questions about OAR.

Ongoing Achievement Record Page - Year 1 Placement 1:

Ongoing Achievement Record Page - Year 1 Placement 2:

Ongoing Achievement Record Page - Year 1 Placement 3:

Ongoing Achievement Record Page - Year 2 Placement 1:

Ongoing Achievement Record Page - Year 2 Placement 2:

Ongoing Achievement Record Page - Year 2 Placement 3:

Ongoing Achievement Record Page - Year 3 Placement 1:

Ongoing Achievement Record Page - Year 3 Placement 2:

Ongoing Achievement Record Page - Year 3 Placement 3:

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