School of Electronic Music Level 3 Extended Certificate

SEM MCR Level 3 Extended Certificate

Student Application Form
Course Selection
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Please ensure you have agreed with any emergency contact that you can give us their contact details. We would only ever contact them in the event of an emergency. If they have any questions regarding this, please direct them to 0161 833 4722 or to email admin@schoolofelectronicmusic.com
Emergency Name
Emergency Phone Number
Where did you hear about us?
I am a citizen of UK, EU, EEA or Switzerland
Do you have any unspent criminal convictions?
Do you have any medical conditions or learning difficulties that we need to know about?
If Yes, disclose below
Additional Comments or Questions
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SEM MCR Level 3 Extended Certificate