Level 2/3 Diploma in Health & Social Care 23/24

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Registration form

Email *

Which level would you like to apply for? *

Health and Social Care Level 2

Health and Social Care Level 3

Required

Which course time would you like to apply for? *

Daytime - 9.30-12.30pm

Evening - 6.30-9.30pm

Name *as you would like it to appear on your certificate *

Home Address *

Postcode *

Do you live within Belfast City Council? *

Yes

Email Address *

Contact Number *

Date of Birth *

YYYY

Gender *

Female

Male

Prefer not to say

National Insurance Number *

Job role *

Company Name *

Company address *

Company contact name *

Company telephone number *

Eligibility criteria - *

I can confirm I have GCSE Maths at Grade C or above or equivalent

I can confirm I have GCSE English at Grade C or above or equivalent

Required

How did you hear about this programme/course? *

Which staff member within People 1st have you spoken to about this programme/course? *

Finance - How will you be financing this programme/course? *

Company

Self

Fully funded

Other:

Company accounts/invoicing email *

Marketing Consent - I would like to be contacted by email *

Yes

Have you been on a programme/course with People 1st before? *

Yes

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? *

Yes

Required

Signed - *

Date *

YYYY

A copy of your responses will be emailed to the address you provided.

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