Request edit access
JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Register your Interest: UCL Leading an Impactful EdTech Enterprise Course
Please fill out
this form
to register your interest to attend this course.
Course leaders Dr Anissa Moeini or Professor Alison Clark-Wilson will contact you to discuss the course and, if your company is eligible, provide a link to register your team.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Your email address
*
Your answer
Telephone number on which you can be contacted:
Your answer
Please state your title/role at Company
Your answer
Name of Company
*
Your answer
Your company's/organisation's address:
Your answer
Year of Incorporation
Your answer
Name and brief description of EdTech product(s)
Your answer
What is your company's mission?
Your answer
What are you company goals for the year?
Your answer
Why are you interested in taking this course?
Your answer
This course is designed for EdTech leadership.
Ideally all those attending will be senior leadership representing various departments in your company. Will you be able to send 2 to 3 members of leadership for the course?
Yes
No
Clear selection
If you are unable to send 2 to 3 senior leadership team members, will you be able to send at least one senior leadership team member along with representative participants from other departments?
Yes
No
Clear selection
Will all course participants from your company be able to fully attend the course at a UCL location in central London, UK from 9:30 am - 4:30 pm on Wednesday, June 18th to Friday, June 20th, 2025?
Yes
No
Clear selection
Please include the names, titles and email of all the participants you would like to attend the course.
Your answer
Can you please confirm if you would prefer to pay by credit/debit card or by invoice?
Credit/debit card
Payment by Invoice
Clear selection
Do you or any of the other participants have any special dietary requirements? Please select:
*
None
Vegetarian
Vegan
Kosher
Halal
Gluten-free
Other:
Required
Do you or any of the participants have any accessibility requirements?
Your answer
If you have any questions you would like course leaders to answer, please ask here.
Your answer
Important information
IOE, UCL's Faculty of Education and Society will store your details on a secure database and we will not disclose, release, sell, rent or loan your details to any third party organisation without your consent.
Please view the UCL privacy policy: https://www.ucl.ac.uk/legal-services/privacy
If you are happy for us to process your data as set out, please tick this box:
Yes
No
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of none.
Does this form look suspicious?
Report
Forms
Help and feedback
Contact form owner
Help Forms improve
Report
