Skip to main content Skip to navigation

HWP Self-referral form

Sexual Misconduct - If you have been affected by sexual misconduct and relationship abuse, please refer to the Sexual Misconduct Policy and Procedures.

Self-referral (please tick one) (required)
Nature of self-referral (please tick one or both) (required)
Attach file
No files are currently attached.

Privacy notice

The University of Warwick will process your personal data for supporting you in your studies. The legal basis for processing your personal data is that it is necessary for the performance of a contract. This data will be used in relation to HWP and FtP concerns that arise during the course. It will not be shared with any third parties external to the University of Warwick except when you have been considered by the WMS FtP Committee. In this case, your FtP and HWP data will be shared in any fitness to practise requests from any recognized professional, statutory or regulatory bodies and provided to the GMC in the Student Fitness To Practise Annual Return. If you are excluded from the University, your data will be entered into the Medical Schools’ Council's Excluded Students' Database. Your HWP and FtP data will be kept securely in accordance with the University's Records Retention Schedule.

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at

Spam prevention

Failure to load reCAPTCHA

reCAPTCHA is a utility used to verify you're not a robot filling out this form. Unfortunately this has failed to load correctly.

Please try reloading the page. If the problem persists, or if you are in a country which blocks Google products, please contact us by using the ‘page contact’ link at the foot of this page.