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 accreditation@aspih.org.uk

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 *
Postcode of employing organisation
Job Title/ Role *
Your role within your organisation
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.
Name of contact *
Name of the person to whom future correspondence should be addressed
Email *
Phone number
(optional)
Please provide any other information below that may be relevant to your accreditation registration
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