Learner Form

Have you completed this form before?
--YesNo

First Name (required):

Surname (required):

Email Address (required):

Telephone Number:

Postcode (required):

Are you Under 25 Years Old? (required):
YesNo

Name of course (required):
—Please choose an option—

Date of course:

Union project that supported learning:

Has / Will this course:

a) Raise the level of your previous qualification (required):
--YESNO

b) Progress you within your career (required):
--YESNO

How do you define your gender?
--MaleFemaleNon-BinaryTransgenderPrefer not to say

DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY?
--YESNO

What is your ethnic group??
A: White
--Welsh / English / Scottish / Northern Irish / Irish / BritishIrishRomaGypsy or Irish TravellerAny other White background, write in below
B: Mixed / Multiple ethnic groups
--White and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed/Multiple ethnic background, write in below
C: Asian / Asian British Welsh / English / Scottish / Northern Irish / Irish
--IndianPakistaniBangladeshiChineseAny other Asian background, write in below
D: Black / African / Caribbean / Black British Welsh / English / Scottish / Northern Irish / Irish
--AfricanCaribbeanAny other Black/African/ Caribbean background, write in below
E: Other ethnic group
--ArabAny other ethnic group, write in below
F: Prefer not to say
--Prefer not to say

Terms & Conditions By ticking this box I acknowledge I have read the policy and agree.

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