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FAQs
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Contact Us
Course Application Form
The London School of Public Health
>
Course Application Form
COURSE APPLICATION FORM
Form ID / Reference No.
Course Applied For
(Required)
Intake / Start Date
Date of Application
1. PERSONAL DETAILS
Title
Mr
Mrs
Ms
Mx
Other
First Name(s)
(Required)
Surname
Date of Birth (DD/MM/YYYY)
(Required)
Gender
(Required)
National Insurance / ID Number
Home Address
(Required)
Postcode
Phone Number
(Required)
Email Address
(Required)
2. EMPLOYMENT STATUS
EMPLOYMENT STATUS
(Required)
Employed (full-time)
Employed (part-time)
Self-employed
Unemployed
Student
Retired
Not seeking work
Other
Current Employer (if applicable)
Job Title
3. EDUCATION STATUS
EDUCATION STATUS
(Required)
No formal qualifications
Secondary / High School
College / Further Education
Undergraduate Degree
Postgraduate Degree
Vocational / NVQ
Currently studying elsewhere
Other
Most Recent School / Institution Attended
Highest Qualification Obtained
4. EQUALITY & DIVERSITY MONITORING (OPTIONAL)
This information is collected for equal opportunities monitoring purposes only. It is not used in the assessment of your application and will be kept confidential.
Ethnicity
White
Mixed / Multiple Ethnic Groups
Asian / Asian British
Black / African / Caribbean / Black British
Other Ethnic Group
Prefer not to say
Disability
No disability
Yes - please give details below
Prefer not to say
Disability details
5. Personal statement
Personal statement
(Required)
Criminal Record Declaration
(Required)
I have no unspent criminal convictions
I have an unspent conviction - details below
Prefer not to say
Unspent Conviction Details
If applicable, please provide details (nature of offence, date, sentence)
6. DOCUMENTATION UPLOAD CHECKLIST
Proof of identity (passport / driving licence / national ID)
Max. file size: 64 MB.
Proof of address (utility bill / bank statement, within 3 months)
Max. file size: 64 MB.
Passport-sized Photo
Max. file size: 64 MB.
Educational certificates / transcripts
Max. file size: 64 MB.
Proof of employment status (e.g. payslip, Jobseeker's letter)
Max. file size: 64 MB.
Disability evidence / support letter (if applicable)
Max. file size: 64 MB.
DBS / criminal record disclosure (if applicable)
Max. file size: 64 MB.
Completed and signed declaration
Max. file size: 64 MB.
Other (please specify below)
Max. file size: 64 MB.
Other document details
7. DECLARATION
Consent
(Required)
I confirm that the information given on this form is true and complete to the best of my knowledge. I understand that providing false information may result in my application being rejected or, if discovered later, my place on the course being withdrawn
Signature
Signature
Your Name
Your Name
Your Name
Your Name
Date
