Personal Details

Level 2 Diploma in Care
Level 3 Diploma in Adult Care
Enquiry Form

To be considered for the above programme, please complete the form below.

Our privacy policy is available at https://www.embarklearning.co.uk/privacy-policy

Which level are you interested in?

Enquiry Details:

Were you aged 19 or over on 31st August?

Yes

Are you a United Kingdom (UK) / Irish Citizen or have the right to live in the UK without any immigration restrictions?

Yes

Have you been living permanently in the UK / Ireland for at least the last 3 years?

Yes

If you have answered No to any of the above questions, unfortunately you are not eligible for funding for the programme. Please do not complete the rest of the form.

Your Personal Details:

First Name(s)*

Surname*

Date of Birth (please use the format dd/mm/yyyy)*

Mobile Number*

Email*

Postcode*

Address 1*

Address 2

Town

County

Preferred Venue*

Name of Job Centre / referring organisation:*

Name of Job Coach / Embark Advisor making the referral (if applicable):

Name of current Employer:

Do you regularly work a minimum of 16 hours per week in the Care sector?

Yes

How long have you worked in the Care sector?

Less than 6 months

6-12 months

12 months or more

Do you already have a Level 2 or Level 3 qualification in Health and Social Care?

Yes

If Yes, please provide the full qualification title, level and year achieved below;

We want to ensure you have the best possible experience on our programme. If you have any disabilities or special requirements that we should be aware of, please complete the box below. This information will help us to make any necessary arrangements and provide appropriate support throughout your learning journey.

Your IP adress is:

Please click the SUBMIT button below - someone from our Team will contact you in the next working day or so.