First Name*
Surname*
Address
Telephone number
Email

I am over the age of 16

Yes

No

School or college*
Address
Telephone number

Do you have any specific requirements that would assist you to participate in our work experience programme?

Yes

No

Do you have any allergies (including food)?

Yes

No

Have you had any experience of bereavement?

Yes

No

What subjects are you currently studying and what are your academic and career ambitions for the future?
What do you consider to be important elements of the services we provide? Who do we provide services to?
Why would you like to be part of a work experience programme at St Margaret’s Hospice Care?
St Margaret’s Hospice vales mean we are patients centred, compassionate, respectful, brave, self-aware, informed and driven, these values are integral to our services. With these in mind how do you feel that would benefit you within your work experience?*

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