Company Details
Only required if a company is enrolling and paying for the student.
Click to upload order form
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Manager’s Details
Additional Contacts for Certificate / Results Copy
Who else must be copied when the certificate and statement of results are sent via email?
Section B: Details of Person Responsible for Payment
To be completed only if payment is not made by a company.
Please enter the name of the person responsible for payment
Please enter a valid email
Please enter a valid telephone number
Please enter a valid ID number
Click to upload signature (image or scanned copy)
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Personal Details
Please enter first name
Please enter last name
Please enter a valid email
Please enter phone number
Please select your gender
Please select your Equity classification
Please select your nationality
Please select your home language
Please select your Citizen/Resident Status
Ability / Disability Status (please select for each category)
Use the scale below for each functional area:
- 1 - No difficulty
- 2 - Some difficulty
- 3 - A lot of difficulty
- 4 - Cannot do at all
- 6 - Cannot yet be determined
- 60 - May be part of multiple difficulties (tbc)
- 70 - May have difficulty (tbc)
- 80 - Former difficulty (not now)
Student / Learner Contact Details
Physical Address
Postal Address
Please select your socio-economic status
Please select your socio‑economic status
Qualifications
Please select your highest qualification
Please enter the name of the school attended
Please select an option