ASPiH Accreditation registration form
Completion of this form confirms an individual or organisation’s intention to submit an application to be considered for an ASPiH accreditation award.

If you require any assistance with this form, please email or contact Jane Nicklin on 07434913388

Email address *
Are you completing this form as an individual, on behalf of an NHS trust simulation centre or an HEI facility? *
Name of employing organisation *
Your answer
Postcode of employing organisation
Your answer
Job Title/ Role *
Your role within your organisation
Your answer
What is your current ASPiH membership status? *
Which accreditation award are you intending to apply for? *
Please give an estimate of the timescale for submission of your completed accreditation application *
How do you anticipate submitting your evidence? *
Please provide details of the shared drive you will use and how access wil be provided to the ASPiH accreditation committee.
Your answer
Name of contact *
Name of the person to whom future correspondence should be addressed
Your answer
Email *
Your answer
Phone number
Your answer
Please provide any other information below that may be relevant to your accreditation registration
Your answer
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