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Your Details
First name: Surname:
Date of Birth: Age:
Current Address:
City: Post Code:
Email Address: Phone Number:
Gender:
Course Information
Course Title:
Course Code (if known):
Preferred Learning Centre: Start Date:
Ethnicity
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Equality and Diversity

We are committed to ensuring fairness and equality to all irrespective of age, disability, gender reassignment, race, religion or belief, sex and sexual orientation or special needs.

ALL INFORMATION GIVEN IS CONFIDENTIAL

Do you have a disability or learning difficulty? Please state yes or no: If yes, please state condition:
Do you have:
Medical conditions:
Do any of the following apply to you?
Language Support
What is you main spoken language (if not English):
Do you require ESOL support (English support for speakers of other languages)?
Your School Details and Results
Name of last school attended:
From: To:

Qualifications

SUBJECT LEVEL AWARDING BODY
(IF KNOWN)
GRADE
(IF KNOWN)
Payment Details (this is only for full cost courses)

If you are paying by credit/debit card please complete the following declaration:

I hereby authorize People Need Skills to charge my account with the amount of £
Credit\Debit Card type (e.g.: Visa/ MasterCard) Card Number:
Name as appears on card: Issue no:(switch only)
Expiry date: Valid date from:(switch only)
Security code:
Notes
Declaration

I declare that all information is correct. I give consent to process the information submitted in this application under the terms of the Data Protection Act 1998.