Registration Form – Course Registration

Name (official name) *

First

Last

*Name attached to your PPS number (for QQI Purposes)

Email *

A valid email address is required for sending and receiving learning materials for your training sessions and assignment work.

Contact Phone Number *

Home Address: (Please include Eircode if available)

PPS Number *

This information is required for QQI certification purposes only

Do you have a medical card? *

This information is required for QQI certification purposes only

Gender *

This information is required for QQI certification purposes only

Date of Birth: *

This information is required for QQI certification purposes only

Employment Status – please select from the drop-down list: *

Course I am interested In: *

Note: We will be in touch with you to confirm your preferred course and location

How did you hear about Aspire Training? *

If referred by a friend, please enter their name below

Your Learning Support Needs – please complete this section if you have particular learning support requirements: *

If you have any learning support requirements, our Course Co-ordinator will contact you, in confidence, to discuss your particular needs.

Funding and Payment Options: *

Please tick the relevant funding /payment option. * Note that approval for the TESG grant from Dept of Social Welfare must be received before the training start date.

Terms & Conditions: *

I confirm that I accept the Terms & Conditions below.

Upon completing this form, a non-refundable deposit is required to reserve your place on the course. Aspire Training reserves the right to postpone or change the date of any course. Learners will be given adequate notice of any required changes to the schedule. Refunds are given only if Aspire Training cancel the training course. Once the course has started, the learner (or funder) is fully liable for the cost of the course. No refunds will be made to learners who do not attend class or do not finish the course. Fees must be paid as per the payment schedule, or as per agreement with the agent funding the course on your behalf. A minimum of 80% attendance is required in order to complete a course.

Privacy Policy: *

I confirm that I have read the Privacy Policy.

Our Privacy Policy outlines how we safeguard your personal data. We request only the information we require to administer your training for QQI certification purposes.

Signature: *

By signing here, I confirm that I have checked all the information which I have provided is accurate and true.

Date: *

e.g. 12/05/2019 or 12 May 2019