FORM FOR STUDENTS TO COMPLETE ONCE THE COMPANY/ORGANISATION HAS ACCEPTED YOU FOR A PLACEMENT
	Your Name, First	Surname
	Date of Birth - Day  Month Yr.	01 02030405060708091011 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar April May June July Aug Sept Oct Nov Dec 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
	Company/Organisation
	Website
	Department
	CONTACT PERSON (for the School to write to)
	Title Forename	Surname
	Address
	Street
	Town
	Postcode
	Tel. number
	e-mail

PLACEMENT

	Yes
28th June-2nd July		Other Dates
5th - 9th July