Section 1: Your Details
First Name (required)
Surname (required)
Mobile (required)
Home Phone
Home Address (required)
Postcode (required)
Sex (required) MaleFemale
Date Of Birth (required)
Email Address(required)
Select Course Level 2 Certificate in Fitness InstructionLevel 3 Certificate in Personal TrainingLevel 3 Diploma in Fitness Instructing & Personal TrainingLevel 3 Diploma in Exercise ReferralLevel 3 Diploma In Personal Training And Business Skills For Fitness ProfessionalsLevel 3 Award in Assessing Vocationally Related AchievementLevel 3 Award in Understanding the Principles and Practices of AssessmentLevel 3 Award in Education and TrainingLevel 2 Award in Instructing Circuit SessionsLevel 2 Award in Instructing KettlebellsLevel 2 Award in Instructing Studio CyclingLevel 3 Award in Nutrition for Physical ActivityOther –
Section 2: Prior Qualifications
All learners must provide details of all prior qualifications and any other form of study as part of the Enrollment Form. You must include results for GCSE English & Maths. If the learner has no qualifications please state ‘None’. Please enter all qualifications.
Section 3a: Ethnicity How would you describe your ethnic origin or personal identity? We are required to obtain this information to monitor the implementation of your Equality & Diversity Policy in relation to the Equality Act using the Government classification of Ethnicity.
Please indicate ethnicity
English/Welsh/Scottish/Northern Irish/British (31)Bangladeshi (41)Irish (32)Chinese (42)Gypsy or Irish Traveller (33)Any other Asian Background (43)Any Other White Background (34)African (44)White and Black Caribbean (35)Caribbean (45)White and Black African (36)Any other Black/African/Caribbean Background (46)White and Asian (37)Arab (47)Any other mixed/multiple ethnic background (38)Any other ethnic group (98)Indian (39)Not provided (99)Pakistani (40)
Section 3b: Support Requirements
All learners need to complete the below. We require this information to ensure that any support you need is available to you.
Please indicate any disabilities, learning difficulties and/or health problem
NONEVisual Impairment (4)Moderate Learning Difficulty (10)Hearing Impairment (5)Severe Learning Difficulty (11)Disability Affecting Mobility (6)Dyslexia (12)Other Physical Disability (93)Dyscalculia (13)Other Medical Condition (95)Other Specific Learning Difficulty (94)Social and emotional difficulties (8)Autism Spectrum Disorder (14)Mental Health difficulty (9)Other Learning Difficulty (96)Temporary Disability After Illness or accident (16)Profound Complex Disabilities (7)Not Provided (99)Asperger’s Syndrome (15)Other Disability (97)
Please indicate which of the above is your PRIMARY disability, learning difficulty and/or health problem
Section 4: Proof Of Identity
Please include passport or driving license document number.
I agree to the privacy policy, terms and conditions and agree to be contacted by National Academy