New Honorary Appointment Approval Form

Details on the policy and procedures for awarding honorary appointments can be found at:

Honorary appointments policy

If you do not qualify for an honorary appointment, but wish to access the University IT facilities, please complete the following form and return it to the relevant Head of School/Head of School Administration for approval:

IT access request form

Please complete the form below to apply for an honorary contract

(a 3 year appointment will be made)

Contact details

If you are completing this form on behalf of someone else, please enter your details

Completed by:
Contact telephone number:
Contact email address:

Applicant details

Please note that the maximum combined size of all uploaded files is 20 Mb

Surname: required
Forename: required
Title: required
Division: required
Date of Birth: required
Nationality: required
Clinical Specialty:
NHS Trust or External Organisation: required
Correspondence Address (preferably your home address): required
Postcode: required
Email address:
A confirmation email will be sent to this address required
Honorary Title Requested: required
Proposed Start Date: required
Proposed End Date:
Contribution to the University:
(please tick appropriate boxes)

Undergraduate
Postgraduate
Research
Teaching
Managerial / Administrative
Other
Please include a supporting statement here from a Senior University colleague:
(either attach a file or enter text into the box below)
For NHS only - a brief letter of sponsorship should also be provided from the Trust Clinical Director/Medical Director or Hospital Dean:
(either attach a file or enter text into the box below)
A current CV must also be attached: required

Validation

Do not fill in the box below.

(the information you submit will be sent to the appropriate Head of Division for approval)