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Full Name
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Gender M/F/Other
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Your Email Address
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Confirm Email Address
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Phone - mobile and landline (if appropriate)
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Address (Correspondence and practice)
Address
Correspondence and Practice addresses, inc postal code
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Date of birth (DD/MM/YYYY)
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Country of Birth
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Your GDC / IDA Number
GDC / IDA Number *
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Country of permanent residence
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Nationality
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If born outside UK
Date of first entry to live in the UK and Residential category (please refer to Notes for Guidelines)
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If you are an overseas student have you IELTS level 7 or above?
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Criminal Conviction
Criminal conviction. If no, state NA. If yes, please state yes. (please refer to Notes for Guidance)
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Disability
Physical or other disability or medical condition which might necessitate special arrangements or facilities
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Which course are you applying for?
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How did you hear about this course?
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In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy
In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

We will not share your information with any third party outside of VSSAcademy and UCLan without your express permission.

Please tick the box below to allow us to contact you to arrange your interview or for information about the course.
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Accreditation of Prior Learning
If you have completed and passed the VSSAcademy Certificate in Implant Dentistry course, please state which year you completed the course and what pass grade/mark you achieved
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Educational background. (Institutions attended)
Please state name(s) of institution, attendance from and to, and whether FT, PT or SW
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Qualifications
Including HND, First Degree, appropriate overseas qualifications and all relevant professional qualifications. Include: type of qualification, Awarding Body, Month, Year, Subject, Grade.
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Employment (Current)
Previous employer. Please state name, address, tel no, nature of work, FT or PT and dates. Please indicate your employment experience including any details relevant to the course for which you are applying.
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Employment (Previous)
Previous employer. Please state name, address, tel no, nature of work, FT or PT and dates. Please indicate your employment experience including any details relevant to the course for which you are applying.
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Employment (Previous ) 1
Previous employer. Please state name, address, tel no, nature of work, FT or PT and dates. Please indicate your employment experience including any details relevant to the course for which you are applying.
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Employment (Previous) 2
Previous employer. Please state name, address, tel no, nature of work, FT or PT and dates. Please indicate your employment experience including any details relevant to the course for which you are applying.
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Employment (Previous) 3
Previous employer. Please state name, address, tel no, nature of work, FT or PT and dates. Please indicate your employment experience including any details relevant to the course for which you are applying.
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Supporting Documents

Please send the required supporting documents direct to courses@vssacademy.co.uk for the attention of Mr Alan Goldie


Please tick which documents you are sending to courses@vssacademy.co.uk
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Next Steps

Upon receipt of your application and relevant documentation, we will invite you for an interview and assessment. These will take place at UCLan Campus, Preston. Following a successful outcome, you will be offered an Unconditional place on the course, via email from UCLan. To proceed you must accept this offer. This will initiate a second email which will contain a link for you to activate your online UCLan membership and log-in details, which are required for the online elements of the course.

Contact Us
If you need to contact us to discuss your application or for any advice, please use the contact details below.

Alan Goldie (Admissions Tutor, UCLan, and Managing Director) VSSAcademy on 020 8012 8400 or by email on agoldie@vssacademy.co.uk.


Thank you for your application.

Questions
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