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Level 5 Diploma in Health & Social Care
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Email
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Your email
Name *as you would like it to appear on your certificate
*
Your answer
Home Address
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Your answer
Postcode
*
Your answer
Contact Number
*
Your answer
Date of Birth
*
MM
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DD
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YYYY
Gender
*
Female
Male
Prefer not to say
National Insurance Number
*
Your answer
Job role
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Your answer
Please confirm within your current role you are carrying out management duties e.g. staff supervision and team meetings
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Yes
No
As this qualification requires significant written communication skills please confirm your literacy level below:
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GCSE grade C and above or equivalent (eg: Essential Skills Communication Level 2)
GCSE below grade C or equivalent (eg: Essential Skills Communication Level 1 or below)
Required
This Level 5 qualification requires a good standard of IT skills, although not a requirement, do you have access to a computer/laptop to complete/upload assignments?
*
Yes
No
Other:
Required
Company Name
*
Your answer
Company address
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Your answer
Company contact name
*
Your answer
Company telephone number
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Your answer
How did you hear about this programme/course?
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People 1st website
People 1st social media
People 1st email ezine
Word of mouth
Google search
Other:
Which staff member within People 1st have you dealt with about this programme/course?
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Your answer
Finance - How will you be financing this programme/course?
*
Company - full invoice
Self - full invoice
Company - monthly payment plan
Self - monthly payment plan
Funded
Company accounts/invoicing email
*
Your answer
Marketing Consent - I would like to be contacted by email
*
Yes
No
Have you been on a programme/course with People 1st before?
*
Yes
No
Under the Disability Discrimination Act 1995 a person is considered to have a disability if he/she has a physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day to day activities. Do you consider that you meet this definition of disability?
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Yes
No
Required
Signed -
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Your answer
Date
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MM
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YYYY
A copy of your responses will be emailed to the address you provided.
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