Phlebotomy Training Registration Form

Course Registration Form

Fill out the form with correct details.
Student/Applicant Name

First NameMiddle NameLast Name
Birth Date

MonthDayYear
Gender

MaleFemaleOthers
Address

Street Address

Street Address Line 2

CityState / Province

Postcode
Mobile Number
Enter Valid Phone number
Student/Applicant E-mail
example@example.com
N.I Number
National Insurance Number
Level in English

Entry LevelLevel 1Level 2GCSE level/Equivalent
Preferred Location for Training

London/LewishamEssex/BarkingBirmingham
Chosen Date
Choose from display/Available dates on front page
Desire Course

Phlebotomy (Introductory Stage 1)Phlebotomy Stage 2 OnlyPhlebotomy Stage1 &2
How did you hear about us?

Word of MouthSocial Media ( TikTok, Instagram etc.)Office AdvertPublic Advert ( Posters, Leaflet etc.)
What best describes your STATUS in the UK?

COS - Skilled Worker/DependantGraduate Visa/DependantBritishEUEU - Spouse/Family RouteAsylum5 to 10 Years RouteIndefinite Leave to RemainDiscretionary LeaveHumanitarian Protection
Would you need any Learning Support/Help?

Diagnosed health issues that could affect progressSupport with English languageSupport with numbersSupport- dyslexiaSpeech, language, and communication needsAutism spectrum disorderNo Help NeededPrefer Not to SayI.T Support
Disability/ Health Issues:

Please tick any box relevant to a physical disability or health need.

Equality Act 2010 – Smartminds Training does not discriminate on the grounds of ‘protected characteristics’.

If you tell us that you have a learning difficulty or disability that has a substantial or long-term adverse affect on your ability to carry out normal day-to-day activities, we will make reasonable adjustments to your learning environment.
Tick Accordingly

Not ApplicableVisual ImpairmentHearing ImpairmentMobility ImpairmentMental Health issuesAsperger’s syndromePrefer Not to SayOthers
I Give Permission for Smartminds Training & Recruitment (Smartminds Empire Ltd) To:
- Get in touch with me about my application’s progress or future opportunities using any of the contact details I have provided.
- Inform me of Smartminds Training events and circumstances which are relevant to me.
- Share my personal data with local authorities and other agencies who may contact me about services relevant to my application and attendance at Smartminds Training.
- I give my permission for my information to be used in my best interests by Smartminds Training personnel and other professionals directly involved in processing my application. I understand that I am obliged to share my personal data with government departments and agencies needed.
- I give permission for Smartminds Training to share with partner organisations my personal information, sufficient only for the purposes of processing electronic payments and providing other services on behalf of Smartminds Training.
- I certify that to the best of my knowledge the above information is true and correct.
- I consent to SMTR and their training partners holding and using the information in this application.
Applicant Signature

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Course Registration Form