[ELS] Academic Course Registration Form

Academic Registration Form

Fill out the form carefully for registration
Candidate's Name*

First NameMiddle Name (where applicable)Last Name
Birth Date*

DayMonthYear
Gender
Address*

Address 1

Address 2

CityState / Province

Postcode
Phone Number*
E-mail*

Confirmation Emailexample@example.com
Unique Candidate Identification Number (UCI) if known
Bill Payers Name & Address
If applicable, please enter bill payers details
Qualification*
Please select entry you want made
Exam Board Please select Examination Board - if unsure please leave blank.

AQAPearson/EdexcelOCRTrinity
Subjects*
Please indicate the subjects you would like to take. E.g Mathematics, Biology, Spanish etc including the subject course code.
Higher, Foundation or Level
If the qualification is tiered, which level would you like to be registered for.
Additional Course Options
.
Do you require Access Arrangements?

YesNo
Signature*

Clear
Date
Would you be interested in tuition or revision classes for GCSE, IGCSE, A Level & Functional Skills. All subjects available.

YesNo
How did you hear about us?*

Google Ad/SearchFrom AQAFrom Pearson/EdexcelFrom JCQFamily/FriendsOther (Please specify)
Terms and Conditions*

I agree payments made after registration are non-refundable after 7 days from date of payment.
You are required to pay any fees outstanding before we can proceed with your exam entry. Candidates (or their parents/guardians) can make a payment with cash in person at our centre or via an online bank transfer payable to East London Skills for Life bank account.

East London Skills for Life Account number : 61601571 Sort Code: 40-06-30
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Academic Registration Form