Agency reference/confirmation of placement for AMHP training at the University of Wolverhampton
It is essential that all parts of the form are completed. This form is required to enable the University to make an assessment about the arrangementsfor placement and suitability of the candidate to undertake AMHP training
Name of agency representative signing the form:
Job title:
Contact details:
Name of candidate:Date of birth:
Candidate’s email address for correspondence with the University:
1. The candidate is applying for (tick one)
Advanced University Diploma in Mental Health Practice for AMHPsSo024Z31UV
Post-graduate Diploma in Mental Health Practice for AMHPs
So019P31
2. Confirm the name of the agency (e.g. local authority) that will fund the course:
Contact details for the invoice (please include postal address as well as email):
OR state that the candidate is self-funding:
3. Tick below to confirm that the candidate is a registered professional (meeting The Mental Health AMHP Regulations 2008, Sch 1):
Social worker registered with the Health and Care Professions CouncilFirst level nurse, registered in Sub-Part 1 of the Nurses’ Part of the Register maintained under article 5 of the Nursing and Midwifery Order 2001, with the inclusion of an entry indicating their field of practice is mental health or learning disabilities nursing
Occupational therapist registered in Part 6 of the Register maintained under article 5 of the Health professions Order 2001
Chartered psychologist who is listed in the British Psychological Society’s register of Chartered Psychologists and who holds a relevant practising certificate issued by that Society
4.The candidate’s registration number is:
5.The candidate has at least 2 years post-qualifying experience of mental health or related health and social care services: Yes/No.
6.Comment on the candidate’sability to meet the requirements of study at the chosen level (degree or masters level):
7. The candidate has undertaken the preparation module Decision-making and interventions with adults in a legal framework Yes/ No
If no, explain the rationale for your assessment that the candidate is prepared for the AMHP course.
8. The candidateis recommended to the University to undertake the course by (name(s) and job title(s)):
9. Thecandidatewill be provided with relevant practice and supervision to enable them to complete the coursework for the module Legal and Policy Context of Mental Health Practice by (name and job title):
10. The candidate will be provided with an opportunity for supervised practice (OSP) by (name the local authority or other agency):
The OSP has been / will be approved and monitored by:
The OSP will meet the requirements set out in the Course Guide. The person approving the OSP will complete the required OSP approval form no later than four weeks before the proposed start date of the OSP.
11. The candidate will be provided with the latest edition of Jones’ Mental Health Act Manual by: (name and job title).
OR State that the candidate is self-funding and responsible for providing a copy.
Signed on behalf of the supporting agency:
Signature (electronic signature will be accepted):
Date:
PTO
Next 6 steps
1. Agency representative should send this document (fully completed) to the candidate.
2. Candidate must complete a University on-line application form.
3. Candidates must upload this document at the same time that they complete the application form.
4. The University will consider both the application form and this document in reaching a decision about whether to offer a place on the course.
5. Candidates will receive a decision from the University- unconditional offer, conditional offer or rejection. Candidates must accept the offer and meet any conditions.
6. Once given an unconditional offer, candidates must enrol. When they are asked for a funding letter as part of the enrolment process, this document should be used.
Page 1 of 3