Declaration of Criminal Records and Fitness to Study and Practice
The following questions are designed to help us assess your suitability to undertake the BSc (Honours) degree in Acupuncture. Such questions form part of the normal application process in organisations such as the British Acupuncture Council, and have been adopted by all accredited acupuncture colleges and courses based in the UK.
Please ensure that you fully disclose all material facts. If you are uncertain as to the relevance of any particular fact, you should disclose it. The information requested here will be treated in strict confidence and may not be divulged to a third party without your knowledge and consent.
Completion of this form is essential for you to be able to commence the programme. Non-disclosure and subsequent discovery of a conviction is regarded seriously.
Your answers will also enable us to give you guidance about your eligibility to register, once you have qualified, with the British Acupuncture Council or in future with a statutory register. However, we cannot guarantee this since the final decision rests with the BAcC/statutory register.
Part A Criminal and civil proceedings
i) Have you ever been under investigation or convicted of any criminal offence?
If ‘yes’, please give details on a separate sheet and include the date of criminal proceedings, the date of conviction and the judgment you were given.
(Professional organisations such as those governing the acupuncture profession, whose members work with children, the elderly or vulnerable adults, are exempt from the provisions of the Rehabilitation of Offenders Act 1974. You must inform us of all convictions, including those that would otherwise be considered spent.)
ii) Have you ever been involved, or are you currently involved, in civil proceedings in matters relating to any professional practice or business in which you are or have been engaged?
If ‘yes’, please state on a separate sheet the nature of these proceedings and whether any judgment was made against you.
iii) Have you ever been subject to any disciplinary proceedings and/or findings against you by any professional healthcare register or other professional register or association, any teaching institution or government authority, whether international, national or local?
If ‘yes’, please give details on a separate sheet of the date when this happened, the nature of the complaint against you and what action was taken or is pending as a result.
iv) Have you ever voluntarily surrendered a licence to practise any healthcare practice, or resigned or been suspended, or been referred for remedial training, in lieu of disciplinary proceedings being taken against you, including your time in education and training?
If ‘yes’, please give full details of the circumstances on a separate sheet.
Part B Fitness to Study and Practise
i) Do you have or have you had an emotional disturbance or psychological illness which might reasonably be considered to impair your ability to study and/or practise acupuncture or any other healthcare profession?
ii) Do you have or have you had a physical illness which might reasonably be considered to impair your ability to study and/or practise acupuncture or any other healthcare profession?
iii) Are you now, or have you been in the past, dependent on alcohol or drugs?
If ‘yes’ is the answer to any of these questions please give details on a separate sheet of the type of condition for which you receive(d) treatment, the dates and the type of organisation(s) responsible for your treatment
iv) Do you have any disability which might reasonably be considered to affect either your ability to practise as an acupuncturist or your ability to complete any of the requirements of the course you are applying to join?
If ‘yes’, please give details on a separate sheet together with details of any special aids or equipment which you might need to study and/or practise acupuncture.
v) Do you have a medical condition, e.g. diabetes, epilepsy, heart condition that might require attention during your time as a student?
If ‘yes’, please give details on a separate sheet together with details of any care that it might be appropriate for College staff to be aware of.
I …………………………. hereby certify that the information provided above is accurate and complete in all respects. I understand that making false or misleading statements, or failing to disclose all material facts, could result in my being suspended or removed from the BSc. Honours degree in Acupuncture.
Signed ………………………………. Date …………………………..
Please read the following notes carefully before completing this declaration form. If you require further information, please contact Peter Mole email@example.com. All enquiries will be dealt with in confidence at this stage.
The College of Integrated Chinese Medicine aims to promote equality of opportunity and is committed to treating all applicants fairly and on merit. We undertake not to discriminate unfairly against applicants because of criminal conviction or other information declared.
We will discuss with you any declared information that we believe has a bearing on your suitability for the programme, and your future qualification.
The information that you provide in this declaration form will be processed in accordance with the Data Protection Act 1998 and the EU General Data Protection Regulation 2018 and will only be used for determining your position on the programme. Once a decision has been made, we will not retain this form for any longer than is necessary (usually 10 weeks) and it will be destroyed at the end of the initial process.
The declaration form will be kept securely and in confidence. Access to it will be restricted to designated persons within the institution. These people are Angela Hicks and Peter Mole.
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Please note: you must inform us immediately if you are charged with any offence in the United Kingdom or in any other country after you complete this form and before you commence practice. You do not need to tell us if you are charged with a parking offence or a speeding offence unless you are disqualified as a result.
"I love the teaching at CICM, it is varied, interesting and extremely inspiring and the teachers all have a wealth of experience to draw on.”
“CICM was suggested by an acupuncturist I know and recommended for its high-quality tuition and professional approach. I knew I wanted to explore a degree course and after my open day experience I knew it had to be CICM.”
"I recently joined CICM and there are so many things I love about the place. The teachers are genuinely helpful and want us to do well. The place has a calm, harmonic feel and studying has already had a tangible benefit to my lifestyle and health."
"I was an electrician before I started studying acupuncture. It might not seem like it but there are overlaps between them, you look at a circuit and work out where the problem is coming from and then rectify it. The difference is with acupuncture I’ll help people to get better!"
"Since embarking on this course, I have been astounded every day by the passion that this subject has sparked in me. I realised very quickly that I was in the right place, doing the right thing. I can only describe it as finally finding my place in the universe and becoming part of something much bigger than myself."
"I wanted to become an acupuncturist as I prefer to use natural remedies which are in line with my faith and cultural background. I have witnessed the profound effects treatment can have on patients. CICM has an excellent reputation and I love the whole package here, especially the staff and supportive teachers."
"I appreciated the integrated style of TCM and the five elements as being the most profound way to reach and help people. This was the best possible start to a long acupuncture career that I could possibly wish for."
"My years at CICM will always hold a special place in my mind. It was like entering Hogwarts. The subjects are mind-expanding, the teachers and tutors really passionate and always keen to answer questions and give guidance. It has transformed me as a person and changed the way I see people, emotions, relationships, disease and health."
The teachers are really supportive and make every effort to tailor how they teach to suit the different styles of students. I like to question things and look at things from different angles - and the teachers have always supported me by being there to answer things by email after class, recommend further reading, or even being there to support me when I set up a Chinese medicine society for the college.
The course covers a huge range of topics, angles and perspectives, and whilst so much of it is new, unfamiliar and challenging at times- especially the 'hands on practical aspects- I can’t think of anything else I’d rather be doing, or anywhere else I’d rather be doing it. CICM is a hub of connection, commitment and energy, and something I am honoured to be part of.
All of my teachers are practicing therapists with a library of information and experience to reinforce their words and the lectures. I have gained a lot of insight into myself and I often find myself reflecting on what we learned in class and applying it to life. I am recommending the course to everyone I know!
As I was in my late forties I was concerned that I was too old, however the Open Day dispelled any doubts that I had as the age range of students and staff spanned from 18 to 80. The beautiful building was a joy to explore and I felt immersed in the world of Chinese Medicine. It was a cocoon of learning in the heart of Reading and only ten minutes’ walk from the train station.