Professional Insights Programme 2025/26 - Practice Registration

1.Practice Name(Required.)
2.Primary contact name for correspondence(Required.)
3.Primary contact email address(Required.)
4.Primary contact mobile number(Required.)
5.Location of office (nearest town or city)(Required.)
6.How many students would you be willing to host?(Required.)
7.Range of insights likely to be provided (tick all that apply)(Required.)
8.Do you have any live sites that the students can visit as part of the programme?(Required.)
9.Small practices and sole traders are allowed to partner up to share the six hours time requirement for the programme. Are you partnering with another practice? If so, please provide the name of the practice you will be working with.
10.By ticking this box you are agreeing to provide six hours of your time to mentor the students between 7 November 2025 and the 10 April 2026. By ticking this box you have also agreed to sign and verify the end of programme form outlining which insights were covered during your time with the students.(Required.)