MSc Booking Form

Add your name *

Full Name

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Gender M/F/Other

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Add your email here *

Your Email Address

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Confirm email

Confirm Email Address

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Add your phone number here *

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?

Yes

N/A

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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?

Part Time MSc Clinical Implantology, Glasgow

Part Time MSc Clinical Implantology, Birmingham

Part timeMSc Clinical Implantology, India

Full Time MSc Clinical Implantology, Preston

MSc in Endodontology, at UCLan

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How did you hear about this course?

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I have read and agree with your Privacy Policy and how you handle my information.

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.

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Please tick the box below to allow us to contact you to arrange your interview or for information about the course.

You have my consent to send me information

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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)

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Employment (Previous ) 1

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Employment (Previous) 2

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Employment (Previous) 3

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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

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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.

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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.

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Questions

if you have any further questions please input in the box below

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Your HTML here...

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Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number *

GDC / IDA Number *

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number *

GDC / IDA Number *

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

Guest details

Full name and title (Given name, family name)

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E-mail Address

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Dental Council India registration number

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Full Practice address

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Mobile number (for whatsapp use only)

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Other (please give details of your dietary requirements)

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Submit

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Deposit: £250 plus vat (£300)

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Select number of places you'd like to book

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How did you hear about this course?

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

Add your name *

Full Name

必填字段！

Gender M/F/Other

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone - mobile and landline (if appropriate)

必填字段！

Address (Correspondence and practice)

Address

Correspondence and Practice addresses, inc postal code

必填字段！

Date of birth (DD/MM/YYYY)

必填字段！

Country of Birth

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Country of permanent residence

必填字段！

Nationality

必填字段！

If born outside UK

Date of first entry to live in the UK and Residential category (please refer to Notes for Guidelines)

必填字段！

If you are an overseas student have you IELTS level 7 or above?

Yes

N/A

必填字段！

Criminal Conviction

Criminal conviction. If no, state NA. If yes, please state yes. (please refer to Notes for Guidance)

必填字段！

Disability

Physical or other disability or medical condition which might necessitate special arrangements or facilities

必填字段！

Which course are you applying for?

Part Time MSc Clinical Implantology, Glasgow

Part Time MSc Clinical Implantology, Birmingham

Part timeMSc Clinical Implantology, India

Full Time MSc Clinical Implantology, Preston

MSc in Endodontology, at UCLan

必填字段！

How did you hear about this course?

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

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.

必填字段！

Please tick the box below to allow us to contact you to arrange your interview or for information about the course.

You have my consent to send me information

必填字段！

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

必填字段！

Educational background. (Institutions attended)

Please state name(s) of institution, attendance from and to, and whether FT, PT or SW

必填字段！

Qualifications

Including HND, First Degree, appropriate overseas qualifications and all relevant professional qualifications. Include: type of qualification, Awarding Body, Month, Year, Subject, Grade.

必填字段！

Employment (Current)

必填字段！

Employment (Previous)

必填字段！

Employment (Previous ) 1

必填字段！

Employment (Previous) 2

必填字段！

Employment (Previous) 3

必填字段！

Supporting Documents

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

必填字段！

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

必填字段！

Next Steps

必填字段！

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.

必填字段！

Questions

if you have any further questions please input in the box below

必填字段！

Your HTML here...

必填字段！

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Deposit: £250 plus vat (£300)

必填字段！

Select number of places you'd like to book

必填字段！

How did you hear about this course?

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

How did you hear about this course?

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Select number of places you'd like to book

必填字段！

Please type your ITI Membership number and Section name

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

You will now be taken to PayPal where you can complete your booking and pay online.

必填字段！

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Course Fee: £2,400 including VAT

必填字段！

Select number of places you'd like to book

必填字段！

How did you hear about this course?

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

You will now be taken to PayPal where you can complete your booking and pay online.

必填字段！

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Deposit: £250 plus vat (£300)

必填字段！

Select number of places you'd like to book

必填字段！

How did you hear about this course?

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

You will now be taken to PayPal where you can complete your booking and pay online.

必填字段！

Add your name *

Full Name

必填字段！

Add your email here *

Your Email Address

必填字段！

Confirm email

Confirm Email Address

必填字段！

Add your phone number here *

Phone

必填字段！

Your GDC / IDA Number

GDC / IDA Number *

必填字段！

Course Fee: £195 plus vat (£234)

必填字段！

Select number of places you'd like to book

必填字段！

How did you hear about this course?

必填字段！

Practice Address *

必填字段！

I have read and agree with your Privacy Policy and how you handle my information.

In order to proceed you must agree to our how we handle your information as mentioned in our privacy policy

You will now be taken to PayPal where you can complete your booking and pay online.

必填字段！

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