Application Form

Personal Details

Please enter your firstname.    
Please enter your surname.    
Please enter your previous surname.  
/ Please enter your Date of Birth in the format dd/mm/yyyy. e.g. 04/03/1980   /            
Please select your gender.   
Please enter the first line of your address    
Please enter the second line of your address    
Please enter the Town/City    
Please enter the County    
Please enter your full UK Post Code      
Please enter your email address e.g. ...      
Please confirm your email address by entering it again e.g. ...        
Please enter a contact telephone number, the education provider may need this if they need to contact you urgently...  
Please enter a work contact telephone number, the education provider may need this if they need to contact you urgently...  
  Please enter your ethnicity.  

Employment Details

  Your Employer.  

Module Information

  The education provider.  
  Module selector  
Mode of Study.  
The University Campus  
[More Information]
Please confirm you have the neccessary prerequisites for this module.  
Learning Commences.  
Have you studied here before?    
If you have studied at this Education Provider before please enter your studentID.  

I confirm that, to the best of my knowledge, the information given in this form is true, complete and accurate and no information requested or other material information has been omitted.

I understand that any offer of a place on the programme I have applied for is subject to approval by my employer and acceptance of the identified education provider’s terms and conditions.

I accept that if I do not fully comply with these requirements, my employer and/or the education provider reserves the right to cancel my application and I shall have no claim against them in relation to this application.

I understand that if plagiarism is proven this information will be shared with my employer.

I agree to comply with University attendance requirements.

I agree to comply with trust requirements for access to SLA funded modules

I agree to the University providing information to my employer on my progression and completion – This will include attendance, withdrawal from modules, confirmation of passing the module (1st, 2nd, 3rd attempt), details of the qualification awarded, or notification if you did not successfully complete the module, including non submission of assessments.

If incorrect information is on your application form, it may not be processed.


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