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Whist completing this enrolment form we will be asking you to tell us about your qualifications, work experience and reasons for enrolling on the course. It will take you a few minutes to complete, and you may save and continue later if you need to.

If your employer is funding your course you will need to complete an employer sponsor form.

Please ensure that you complete all fields which are marked with a asterisk ( * ) as these are mandatory fields. Before submitting the form, please check that you have completed all necessary fields, as the enrolment form will fail to submit if you are missing required information. If you require any assistance or have any difficulties completing the form, please contact our office team on 020 8239 1323.

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Name*
Title First Last
Address*
Street Address City ZIP / Postal Code Country
Employment Status*
Employer Name*
Job Title*
Work phone*
Work email*
Personal email*
Mobile phone*
Home phone
Date of Birth (dd/mm/yyyy*

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Course Applying For*
Course / Level*
Location Preferences
Fees*
Line Manager contact details*
Please provide contact details of your line manager.
Name Job Title Email Address Phone Number
Payment Method*
Apprenticeship Contact*
We need the details of the key contact in your organisation who can authorise using the apprenticeship levy.
Name Job Title Email Address Phone Number
Head Office Address*
Street Address City ZIP / Postal Code Country
English & Maths*
Do you have copies of your certificates for GCSE English & Maths (or equivalent)? We will need to see copies before you start the apprenticeship.
- I have GCSE English
- I have GCSE Maths
- I don't have copies of my certificates
Upload employer sponsor form
Preferred Start Date (dd/mm/yyyy)
Date Format: DD slash MM slash YYYY

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Professional Statement*
*
*

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Communication*
Equality & Diversity Information
We ask all our learners to answer the following questions to help us monitor and evaluate the equality and diversity of our courses.
Learning Needs
Do you have any special requirements in relation to your studies that we should be aware of or any disability (e.g.Dyslexia) that you feel may affect your learning?
Do you want to add anymore information about yourself that you think will be important?

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Declaration*
- Select All
- I confirm that, to the best of my knowledge, the information given on this form is correct
- I understand that this is an enrolment form and not an application form or a suitability check for the course. If you are unsure about which course to select, please contact us on 020 8239 1323 *
- I understand that completing and submitting this enrolment form I accept liability for the payment of the course fees on confirmation from Acacia Learning of enrolment. (You will have confirmation within 2 working days) *
- I have read and agreed to your Terms and Conditions
Please tick the boxes to complete your enrolment:
Signature*
Learner's Name
Date (dd/mm/yyyy)*
Date Format: DD slash MM slash YYYY
Name
This field is for validation purposes and should be left unchanged.

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