Mohair Centre Training
REGISTRATION FORM
NAME:
ADDRESS:
POST CODE:
E-MAIL ADDRESS:
PHONE NUMBER HOME: MOBILE:
DATE OF BIRTH:
PLEASE CIRCLE THE QUALIFICATION YOU WISH TO APPLY FOR:
Transitional Modules in Playwork (Early Years -Playwork)TRANS
Diploma in Playwork (QCF) LEVEL 2 4964-02 PLAY2
Diploma in Playwork (QCF) LEVEL 3 4964-03 PLAY3
NVQ Children’s Care, Learning & Development Level 4 (CCLD4) 3171-04 UNTIL DECEMBER ONLY
Certificate Children & Young People’s Workforce Level 2 CERTIFICATE (QCF) 4227-01
Diploma Children & Young People’s Workforce Level 3 DIPLOMA (QCF) 4227-03
PTTLS Preparing to Teach in the Lifelong Sector LEVEL 3 7303-03
Assessor Award QCF (TAQA) 6317-03
Internal Verifier Award QCF (TAQA) 6317-04
SHORT COURSES:
(Please Tick the one you are applying for)
First Aid Course
Manual Handling
Makaton
Safeguarding
MAIDEN NAME (if applicable):
WORKPLACE ADDRESS AND PHONE NUMBER:
LINE MANAGER:
SOURCE OF FUNDING
(PLEASE TICK)
SELF FUNDED
CEYCP (Brighton)
EYCESS (East Sussex)
OTHER: Please State
TRAINING MONITORING
Gender (Please circle where appropriate)
Male Female
Please specify below whether you have any additional needs:
Age: 16-24 25-49 50+
Ethnicity (Please specify) :
Candidate Signature: Date:
Please print and return this form to: MOHAIR CENTRE TRAINING
2 Park Farm Cottages, Laughton, Lewes, East Sussex, BN8 6BU Telephone Number: (01825) 840759 Email: mohaircentretraining@hotmail.co.uk
