Application form - Summer 2025

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Your details

Thank you for your interest in gaining work experience within Lewisham and Greenwich NHS Trust which is being delivered in partnership with Pathway CTM. This application form is designed to help us understand your career aspirations, and areas of interest so that we can match you with relevant and available placement.

This form is for non-medical placements only. Please follow the process for medical placements if you are an aspiring doctor and wish to undertake a medical placement.

About you *

First name	*
Second name	*
Email address	*
Telephone number	*

1. What is your home address *

Address line	*
Address line 2	*
City	*
Postcode	*

2. Which local authority do you line in? *

Lewisham
Bromley
Bexley
Other (please specify):

3. What is your age and year group? *

	Year 10	Year 11	Year 12	Year 13
15years	15years Year 10	15years Year 11	15years Year 12	15years Year 13
16years	16years Year 10	16years Year 11	16years Year 12	16years Year 13
17years	17years Year 10	17years Year 11	17years Year 12	17years Year 13
18years	18years Year 10	18years Year 11	18years Year 12	18years Year 13
19years	19years Year 10	19years Year 11	19years Year 12	19years Year 13

Other - Please specify