Full Name * (as you wish it to appear on your certificate)
Name of Organisation/Company funding your course
Type of Photo ID you could provide upon request if required
Email address (required)
Date of Birth
---1 - Asian or Asian British - Indian2 - Asian or Asian British - Pakistani3 - Asian or Asian British - Other4 - Black or Black British - African6 - Black or Black British - Caribbean14 - Black or Black British - Other9 - Mixed - White & Asian11 - Mixed - White & Black Caribbean15 - Mixed - Other7 - Chinese18 - White - British20 - White - Irish22 - White - Other17 - Prefer Not To Say
National Insurance Number
ULN (Unique Learner Number if you have one)
Have you previously been registered with FutureQuals for any other qualifications? (If yes please contact your previous Training Provider to gain your Learner Code)
How did you hear about Footstep Training?
Address line 1
Address line 2
- Visual Impairment2 - Hearing Impairment3 - Disability Affecting Mobility4 - Other Physical Disability5 - Asthma / Epilepsy / Diabetes6 - Emotional Behaviour Difficulties7 - Mental Illness8 - Temporary Disability after Illness9 - Profound Complex Disability90 - Multiple Disabilities97 - Other98 - No Learning Disability
[1- Learner considers him/herself to have a learning difficulty/disability/health problem2-Learner does not consider him/herself to have a learning difficulty/disability/health problem9 - No information provided by learner "]
Special Needs- please request the full list if not shown below
NoYes"99 - No Disability""98 - Not Known/Not Provided""97 - Other""96 - Yes/Prefer Not to Say""01 - Hearing""02 - Learning""03 - Multiple""04 - Visual""05 - Mobility""06 - Physical"
Specific Learning Difficulty
1- Moderate""2 -Severe""10 - Dyslexia""11 -Dyscalculia""19 - Other specific learning difficulties""90 - Multiple learning disabilities""94 -Specific Language impairment""95 -Asperger’s / Autism" "96 - ADD / ADHD""97 - Other""98 - No learning difficulty" "99- Not known / information not provided"
Additional Learning Needs
11- Additional learning needs""12 -Additional social needs""13 - Additional learning and social needs""97 -Learner has been assessed on entry as having no additional social needs""98 - Learner awaiting assessment""99 - Not known / information not provided"
I agree to pay the full balance of my qualification and understand that I will not be issued my achieved certificate until all funds have cleared. I understand that I have 12 months (Level 3), 24 months (Level 4), and 36 months (Level 5) to complete my qualification. If I require additional time I understand it will incur additional costs at a rate stated by Footstep Training. I am aware there is no minimal time required to complete the qualification. I understand that excessive submissions of the same assignment may also incur additional costs. I am aware this is an online learning qualification and requires supplementary reading and study in addition to the tutorials provided. I confirm that by ticking the boxes in the table I have read, understood, and agree to the policies.
Please confirm, by ticking the boxes, that you have read, understood, and agree to comply with the following:
Equality and Diversity PolicyHealth and Safety PolicyAppeals Policy and ProcedurePlagiarism Policy and Referencing of sourcesAccess to Fair Assessment PolicyComplaints Policy and ProcedureTerms and conditions, and agreementLearner Privacy Notice https://www.i-l-m.com/privacy/learnerpersonaldataI agree for my data to be collected and stored
As soon as we receive your details and payment we will send you your login details to the online learning site. If you wish to provide feedback to us at any point please email email@example.com
Upon successful completion of your qualification, you will be able to progress to other qualifications and will be offered a “returning student” discount on any of Footstep Training’s courses. To find out more about what qualification you can progress to please visit www.footstep-training.com