APAAC Application Form

APAAC

Full Name

Date of Birth

Email Address

School/College/Organisation

Work Address

City

County

Postcode

Country

Work Phone Number

Home Address (only required if self-funding and different from work address)

City

County

Postcode

Country

Please give a brief description of your current role

Briefly describe why you are intending to take this qualification

Supporting your application

Do you have the support of your Head of Centre or Line Manager to apply for this course?

Yes

Not applicable (self-funding)

Head of Centre/Line Manager Name:

Head of Centre/Line Manager Email Address:

Start Date

Please state the date you would be available to begin the course. (We have start dates at the beginning of each month; starting the course is dependent upon the required paperwork being received before the requested start date).

Requested start date

Reasonable Adjustments

Please let us know if you have disabilities or difficulties which may require reasonable adjustments:

Payment information

Course Options

Coupon Code

Total

Payment method

Pay online with Credit/Debit card

Please send me an invoice

Please provide a purchase order number below; we cannot accept applications without this. If you are self-funding, please use your surname in place of a purchase order number.

Please make sure this covers the course fee in full

Please provide us with your finance office email address for us to send an invoice to. If you are self-funding, please give your email address.

Payment

Photo ID

Please Attach Photo Identity

Maximum file size: 5MB

e.g. a photocopy of your Driver's licence or Passport. If you are successfully accepted onto the APAAC, this will be used to verify your identity with our awarding body.

How we use your information

Include-ed will use the details on this form to communicate with you about your course (including login details and payment), and for record-keeping. A cropped version of your photo ID is used to confirm your identity in the videoed assessment and will be securely deleted once the moderation window has passed for your course.

We would love to stay in touch following your course and provide occasional information and offers for relevant training courses or resources. Please let us know if you are happy to hear from us:

Yes, that's fine

You can change your mind at any time by clicking the unsubscribe link in the footer of any email you receive from us, or by contacting us at debbie@include-ed.org.uk. We will treat your information with respect and will never spam you or sell your information to third parties. You can view our full Privacy Policy here.

If you would like to opt out of all future marketing communications from Include-ed now, please tick here

Where did you hear about the APAAC course?

Declaration

I hereby certify that:

All the information I have given on this form is correct.
I have watched and understood the 'Introducing the Award of Proficiency in Access Arrangement Coordination’ video (at this link).
I understand that I need a good level of written English, a high level of self-motivation, good organisation and time management skills in order to complete the course.
I agree not to allow anyone other than the registered Include-ed Student to watch any of the Include-ed or Communicate-ed videos (with the exception of the training course in Assignment 9) and will not pass on the login details or course materials to anyone else.
I understand that I have 3 months from my start date in which to complete the course, and confirm that I have the time to commit to the course requirements alongside other commitments.
I have been informed of the course fees and understand what is included in the fee and what is an additional cost (see ‘APAAC Course Fees’ for details). I have provided a purchase order number to cover the fees.
I understand that if I am unable to complete the course or if I do not pass, my fees will not be refunded.
If my employer is paying for the course, I give permission for my progress to be discussed with them.

Signature

Clear

Date