Course Choice * Please choose... Understanding Autism Understanding Children and Young People’s Mental Health Common Childhood Illnesses Information, Advice or Guidance Working with Individuals with Learning Difficulties Behaviour that Challenges Care Planning Dementia Care Nutrition and Health Mental Health Problems Dignity and Safeguarding in Adult Health and Social Care Safe Handling of Medication Prevention and Control of Infection End of Life Care Care and Management of Diabetes Common Health Conditions Falls Prevention Awareness Equality and Diversity Understanding Safeguarding and Prevent
Learning Method * Please choose... Online learning materials with online assessment Paper based assessments with a book
Do you consider yourself to have a learning difficulty and/or disability and/or health problem? * Please choose... No Yes
Primary: * Please choose... Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 2: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 3: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 4: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 5: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Please select your ethnic origin: * Please choose... African Arab Bangladeshi British Caribbean Gypsy or Irish Traveller Indian Irish Other Asian background Other Black background Other Chinese Other Mixed background Other White background Pakistani White & Asian White & Black African White & Black Caribbean Any other Not known / Prefer not to say
Employment Status: * Please choose... Employed Not Employed
Employment Type: * Please choose... In paid employment – 0–10 hours per week In paid employment – 11–20 hours per week In paid employment – 21–30 hours per week In paid employment – 31 hours or more per week Self employed
Hours worked per week: * Please choose... 0–10 hours 11–20 hours 21–30 hours 31 hours or more
Date commenced current employment: * DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM 1 2 3 4 5 6 7 8 9 10 11 12 / YYYY 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Unemployed Type: * Please choose... Not in paid employment and looking for work Not in paid employment and not looking for work In full-time education prior to the start of the course Retired
Date from which you were not employed: * DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / MM 1 2 3 4 5 6 7 8 9 10 11 12 / YYYY 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920
Preferred Contact Method: Please choose... Text Phone Email
Form of ID given: Please choose... Driving Licence Passport Birth Certificate National Identity Card
