Later Life Training Course Application Form

1 Your details

2 Eligibility

3 Choose Your Course

4 Additional Info

5 Payment Information

Name*
FirstLast
Gender*
- Male
- Female
Date of Birth*
Contacting you by Email
Primary email address (work or home) – please also give us a Secondary email address (work or home) just in case we cannot contact you on your primary email address. We will use the primary email address unless for any reason this does not work.
Primary Email*
Secondary Email*
Your Postal Address
Postal address where we will send your course information. Must be able to take delivery of a large parcel.
Address*
Address (everything except City/Town/Village, County and Postal Code.)City/Town/VillageCountyPostal CodeCountry
Your Telephone Numbers
Home Telephone*
Work Telephone*
Mobile Telephone*

Which course do you wish to apply for?*
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Which course do you wish to apply for?
Any other courses you may be interested in in the future?
If you wanted to apply for a course for which there are no current dates, choose the same course under this section.

Do you have any Medical Conditions LLT should be made aware of?*
We ask that you inform us about any medical conditions so that, where appropriate, we can help you access our course content and learn effectively. All information will be treated confidentially.
- Yes
- No
Medical Condition Details*
Maximum of 1000 characters
Do you have any Learning Support Requirements LLT should be made aware of?*
We ask that you inform us about any learning support requirements so that, where appropriate, we can help you access our course content and learn effectively. All information will be treated confidentially.
- Yes
- No
Learning Support Requirements Details*
Maximum of 1000 characters

Payment
Who will pay for you to attend this course?*
- I will - invoice will be sent to address provided in Step 1
- My Funder Will - details required
Funders Name*
FirstLast
Funders Email*
Funders Telephone*
Discount
To find out more about discounts on LLT courses, click here (opens in a new window).

Application for a discounted cost must be made with this application and will not be accepted if made retrospectively
PSI Discounts
Choose one of the following:
- AGILE - 10% off
- EfS Qualified - 10% off
EfS Discounts
- ACPIN - 10% off
- Different Strokes Qualified - 10% off
- PSI Qualified - 10% off
MMe/SLMe Discounts
- AgeUK volunteer - 10% off
Terms and Conditions
Please confirm*
- I have read and understood the Terms & Conditions related to my specific course.

Application Form