Private Candidate Exam Application Form

Private Candidate Exam Application Form
Candidate Details
Name*

First NameLast Name
Date of birth*

DayMonthYear
Age*
Gender*
Unique Candidate Identifier (UCI) – 12 digits
Unique Learner Number (ULN) – 10 digits
Home Address*

Address

Address 2

Town/CityCounty

Post Code
Contact Information (e.g. parent)

This is the person who we should contact with any questions/updates about your booking. If this is the same as the person taking the exams, please put yourself.
Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Send invoice to (if different from above)
Name
Email
example@example.com
Any additional information - please note the only access arrangement we can accommodate is extra time
Exam Series - Summer 2025

Exams*

	Exam Board	Qualification	Subject Code	Subject	Unit Code (paper)
1
2
3
4
5
6
7
8
9
10

Terms and Conditions
Data Protection Act 2018: The information on this form will be held both electronically and as a hard copy for the purposes of candidate account administration within Connie Rothman Learning Trust, and will be destroyed when
the examinations are complete. Data will not be disclosed to any external without your express written consent.
1. You are solely responsible for answering all questions honestly, completely and to the best of your knowledge and also for ensuring that any assumptions are correct. Failure to do so may lead to incorrect exam registrations and you may not be able to sit for exams.
2. If you have not sat any examinations before in UK, you will not have a UCI or ULN. If you have a UCI and ULN then you can find it on your previous certificates and Statement of Entry. Each examination that you sit will require your unique Candidate Number, as well as the Centre Number. So please take
  note of the numbers given to you.
3. If due to special circumstances, you have previously been given additional time to complete examinations, you must inform Private Exam Centre at the time of registration. Supporting documentation for additional time allowances is also expected at this time. Special requirements and extra time request must be approved by the exam board of the allocated centre. Unit codes for each syllabus that you are sitting are found in each syllabus, along with the course name. Please check the code carefully before entering it into the form, as many of the unit codes are similar. Private Exam Centre cannot be held responsible for mistakes made on the registration form. To ensure each
  candidate receives the correct papers that he or she has studied for, please clearly indicate all paper choices for each subject.
4. Once the registration form is completed, we will calculate the total payment from the exam officer and we will request you to pay in full. In case of cancellation of your exams with a sufficient time (depends
  on exam board dead line) we will refund your exam fees and deduct the £50 per application from total fees as our administration fees. Any cancellation requests must be received with 21 days of payments and must be before the first deadline by the exam board. No refunds will be issued for applications
  submitted after the first deadline.
5. When your registration and payment is processed, a Statement of Entry will be sent to your email address. Please check over the Statement of Entry carefully for any errors – notify us as soon as possible to resolve any issues. IF there are two examinations timetabled for the same time on the same
  day, you will take one examination after the other, with a short break between examinations but under centre full supervision.
6. Please note that for all your examinations, you must bring your Statement of Entry and photo identification (passport/driver’s license) to present to the invigilator. Please note that there will be NO REFUND of any fees after the first deadline by the exam board or absent of any exams by any reasons.
7. The Connie Rothman Learning Trust will disclose relevant personal data, including name, date of birth and gender, to the awarding bodies for the purpose of examining and awarding qualifications
I have read and agree to the terms and conditions
Date

DayMonthYear
Date
Should be Empty:

Private Candidate Exam Application Form

Candidate Details

Contact Information (e.g. parent)

Send invoice to (if different from above)

Exam Series - Summer 2025

Terms and Conditions