Enrolment form

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Enrolment form

This Enrolment form is used as part of your initial assessment, and to help get you registered with the awarding body, Please Print your full name as you wish it to appear on the certificate, and we need your home address as this is where we would post your certificate to.

Name of course *

CHAP

Level 5 Assistant Practitioner

Level 3 in Education and Training

Level 5 Leadership and Management in Care Diploma

Level 3 Health and Social Care

Other Level 2 course

Other Level 3 course

If you chose other Level 2 or 3 course above, please put the name of the course you are enrolling on here.

Your name (first and last) *

Your employers name *

Are you self funding this course? *

If you are self-funding, how would you like to pay *

Lump sum

Monthly instalments

My employer is funding

Name and email address of where we should send the invoice to *

Your date of birth *

YYYY

Your home address and post code *

Your email address *

Your phone number *

Your highest level of qualification *

A-C GSCE / NVQ2

D-U GCSE / NVQ2

A Level / NVQ 3

NVQ 4

NVQ 5

BSc / BA - NVQ 6

Ma / NVQ7

Phd / NVQ 8

Have you taken any exams in English? Please give details *

Have you taken any exams in Maths? Please give details *

Are you confident in using the computer / internet? *

Yes

Do you know your learning style? If so please complete this question

You can find out your learning style at https://arden.ac.uk/what-type-learner-are-you

Visual (spatial):You prefer using pictures, images, and spatial understanding.

Aural (auditory-musical): You prefer using sound and music.

Physical (kinesthetic): You prefer using your body, hands and sense of touch.

Logical (mathematical): You prefer using logic, reasoning and systems.

Social (interpersonal): You prefer to learn in groups or with other people.

Solitary (intrapersonal): You prefer to work alone and use self-study.

Verbal (linguistic): You prefer using words, both in speech and writing.

Don't know

Do you consider yourself neurodiverse? *

Autism

Dyslexia

Dyspraxia

ADHD

Other....................................

Do you consider yourself to have any physical disability? *

Epilepsy

Hearing

Eye sight

Other

None

What gender do you identify as? *

Male

Female

Non-binary

Prefer not to say

Do you / have you ever identified as transgender? *

Yes

Maybe

Prefer not to say

What age are you? *

Do you consider yourself to be disabled? - The Equality Act 2010 defines disability as ‘a physical or mental impairment which has a substantial & long term effect on a person’s ability to carry out normal day to day activities’. *

Yes

Maybe

Identity - Please specify how you would describe your national identity: *

British

English

Irish

Welsh

Scottish

Other

Prefer not to say

Sexual Orientation *

Heterosexual

Lesbian

Bisexual

Gay

Prefer not to say

What is your religion or belief *

Health & Wellbeing - Please tell us any information that we might need to know why we are teaching you. Please note this could be to do with your personal Health or your mental health. Please answer this question: What do we need to do for you if you become unwell. (if nothing please write N/A) *

If you consider yourself neurodiverse have you had a formal assessment? *

Yes

N/A

Reasonable Adjustments - Please let us know what you feel might help, However we will need to apply to the awarding body in line with our Reasonable Adjustments policy. *

Print resources on coloured paper, and change background colour of computer screens and presentations.

25% additional time

Support with reading

Support with writing

N/A

Other:

Why do you want to take this course? *

What do you hope to get out of this course? *

Do you know want to know more about your next steps within Education and Training *

Yes

Maybe

I hereby give my consent for the information provided on this form to be held on computer or other relevant filing systems and to be shared with other accredited organisations or agencies in accordance with the GDPR 2018, I understand that the Awarding Body's will hold my information for contractual requirement of 7 years. * *

I understand and give consent

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