CAS - Distance Learning Application Referral Form

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CAS - Distance Learning Application Referral Form

Personal Details
Your Address
Course Choice
Health, Disability and Additional Learning Support

Personal Details

Title

First Name

Surname

Date of Birth - Day

Month

Year

Email Address

Phone/Mobile

Sex (as stated on your birth certificate)

Gender

Health, Disability and Additional Learning Support

To help you succeed, it is important that we are aware of any additional support that you may need. This will allow us to arrange any reasonable adjustments to support your needs.

Do you have a disability, learning difference, medical condition, or a mental health condition that impacts on your engagement with learning?

Yes

Please let us know a little bit more about your disability, learning difficulty or health conditions which may affect your course:

If other, please provide further details:

Please let us know a little bit more about your disability, learning difficulty or health conditions which may affect your course:

If other, please provide further details:

Please provide any additional information that will help us to identify the support you will need:

What we do with the information we gather

We require this information to understand your needs and provide you with a better service, in particular for the following reasons:

We will use the contact details provided to invite you to attend information and enrolment events in relation to your course and to request further information from you, where required, to support the admissions and enrolment process and to keep in touch with you before starting your course.
We may use the information provided to monitor and support your progress as a student.
We may use the information to improve our products and services.
We may periodically send promotional emails about new products/services or other information which we think you may find interesting, using the mail address which you have provided.
From time to time, we may also use your information to contact you for market research purposes. We may contact you by email, phone or mail.

Your personal information

By completing this form you are giving your consent to us processing your personal information in this way. We will not sell, distribute or lease your personal information to third parties unless we have your permission or are required by law. You have the right to request details of personal information which we hold about you.

For further information about we use and store your personal data, please read our Privacy Policy.