NEW - ECEPC Application form

APPLICATION FORM

Important course information - please read the following Terms and Conditions before applying to take the ECEPC course.
Application eligibility criteria & study requirements
- Possession of a relevant professional healthcare qualification including registration with a recognised professional body
- Working in a suitable practice setting and direct contact with patients requiring palliative or end of life care.
- Access to email, internet and Zoom/Teams
- Able to commit an appropriate amount of time to study during the 9 week duration of the course and available for the mandatory remote assessment day at the end of the course

Payment
- Applications can not be accepted without full payment details.
- Course fees can be paid by card at the time of application or via employer invoice. Bank transfer and cheques are not accepted.
- We require a Purchase Order / reference number for all invoice requests.
- All invoices must adhere to our strict 30 day policy - failure to do so may jeopardise your place on the course.
- Certificates will not be issued until payment is cleared.

Withdrawal and Deferral
- Requests to withdraw or defer must be made in writing using the correct proforma

- If a candidate wishes to withdraw from the course after the commencement of the course, the candidate will receive no refund and any remaining fees due will still be payable.
- If a candidate wishes to withdraw from the course before the commencement of the course, a refund or transfer of the place may be considered but an administration charge may be levied.
- If a candidate wishes to defer to a later course, each request will be considered on a case-by-case basis and an administration fee of £150 will be levied.

Cancellation by us
Occasionally, situations beyond our control may mean we have to cancel a course. In the unlikely event that a course is cancelled, delegates will be informed as soon as possible and offered a priority place for the next available course or a full refund of fees paid if they prefer.

Learning resources and Assessment

Candidates will be offered a choice of either paper copy or electronic version of the course learning handbook. Paper copies will be postage paid within UK but international candidates will be required to pay relevant postage rates.

All candidates will be offered two attempts at each element of course assessment. Second attempts are taken with the next cohort. Candidates that fail to pass the assessment after two attempts may re-purchase the course.

Due to the nature of the course content, it is not advisable to undertake this course if you have had a recent bereavement yourself.
I confirm that I have read these conditions and wish to apply for the ECEPC course*

Yes
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Fields marked with * are mandatory to complete. If the 'next' button does not work check you have completed all fields.
The closing date for applications is four weeks prior to the commencement of the course (or when all available places have been filled, whichever is sooner). Applications received after this date will not be considered and places will be allocated for the next course.
Please select which course dates you wish to attend *
Please indicate your preferred 'site'. We will try to accommodate where possible but this cannot be guaranteed if your chosen site is full.*

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Payment

Please note that confirmation of a place will not be possible without completed payment details.
I would like to pay...*

I am self-funding and would like to pay online nowMy employer is funding the course and can pay online nowMy employer is funding the course and I have invoice details

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Payment by invoice

We require a purchase order (PO) number or reference for each application unless you can provide written confirmation from your employer / trust that one is not required. We also require the contact name and address of the person expecting to receive the invoice & pay the course fees.
Name of person to invoice (This should not be your line manager)*

TitleFirst NameLast Name
Role within Finance / funding department*
Organisation or Trust to invoice*
Purchase Order/ reference number*
Address for invoice*

Address Line 1

Address Line 2

City/TownCounty

Postal CodeCountry
Phone Number (of person to invoice)
Please remember to include your international prefix (e.g. country code before your number +44 7395.... for UK)
Email address (of person to invoice)
example@example.com
Card Payment

Your payment will be processed by Stripe who use the strictest payment processing procedures and has been audited and certified to PCI Service Provider Level 1

Total cost GBP

Credit Card Details
First Name	Last Name
Credit/Debit Card Number	Last 3 digits on back of card
Card Expiration

Fields marked with * are mandatory to complete. If the 'next' button does not work check you have completed all fields.
Course Learning Resources

As a remote learning course, all course content and learning resources are provided on our online platform, Learningzone. However, we can provide a paper copy of the handbook if required.
Please indicate your preference below*

Yes, I would like a copy of the handbook posted to me at my home addressNo, I do not need a paper copy, I am happy to access it online
Keeping in touch

We’d love to keep you up to date with more Education services offered by Princess Alice Hospice via email. Would you like to hear about further education sessions and study days?
Please confirm*

Yes, please send me further education marketing informationNo, I don't want any further information
Where did you hear about this course?*
Princess Alice Hospice will not share, swap, rent or sell participants details to other charities or third parties for marketing purposes. You can read how we manage and respect your data in our Privacy Notice at www.pah.org.uk/privacy

If you’d like to change your permissions at any time please contact education@pah.org.uk
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APPLICATION FORM

Personal Details

Payment

Payment by invoice

Card Payment

Course Learning Resources

Keeping in touch