Start Date:

Finish Date:

Training Hospital:

Please select Training Hospital St. Patricks University Hospital St. James’s University Hospital Health Service Executive Mental Health Children Health Ireland Tallaght University Hospital Muiriosa Service, Mooreabbey Stewarts Care Services Coombe Women’s Hospital Rotunda Women’s Hospital

Emails details for ALO in training hospital:

Please select ALO from training hospital Ms. Marie King SPUH Ms. Elaine Kennedy SJUH Ms. Bernie Kelly HSE MH Ms. Elizabeth Fitzpatrick CHI Ms. Helen Teague TUI Ms. Sinead Landy RT Ms. Denise Kiernan CWH Ms. Nadine Sheridan MA Ms. Lisa Forde STEW

I declare that I will complete all Health screenings required and submit evidence as needed to the university I am visiting before I can attend any clinical placements abroad.

I declare that I will complete Police Clearance as required by the university I am visiting and submit evidence before I can attend any clinical placements abroad

I acknowledge that if you do not complete all the above, prior to my agreed arrival date, i will not be permitted onto clinical placments.

I consent to the processing of my personal data for sole purposes of Trinity College Dublin [Application for clinical placements - Outgoing]. I understand that my personal data will be processed in accordance with the Trinity College Dublin Privacy Notice.