APPLICANT DETAILS

Title

First Name (required)

Middle Name(s) (required)

Last Name (required)

Date of Birth (required)

Gender (Please Select) (required)
MaleFemaleOtherPrefer Not to Say

Passport/ID Number (required)

Address (required)

Post Code (required)

ETHNICITY

Please Select Ethnicity
BritishIrishGypsy / Roma/ Traveler of Irish heritageAny other white backgroundsWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other mixed backgroundsIndianPakistaniBangladeshiAny other Asian backgroundCaribbeanAfricanAny other Black backgroundChineseAny other ethnic backgroundDecline to record ethnicity

LEARNERS WITH A DISABILITY OR LEARNING DIFFICULTIES

Do you consider yourself to have a disability, health problem or learning difficulty? (required)
YesNoPrefer not to say

If you answered ‘Yes’ and you have a disability or health problem, please tick (Disability)
Visual impairmentHearing impairmentDisability affecting mobilityOther physical disabilityOther medical condition (e.g. epilepsy, asthma, diabetes)Emotional / Behavioural difficultiesMental Health DifficultyProfound complex disabilitiesAsperger’s syndromeMultiple disabilitiesTemporary disability after illness (e.g. post-viral) or accidentNot known / Information not providedOther

Learning Difficulty (required)
Moderate learning difficultySevere learning difficultyDyslexiaDyscalculiaAutism spectrum disorderMultiple learning difficultiesNot known / Information not providedOther

PLEASE TICK THE MAIN REASON TO UNDERTAKE APTIS ESOL

Are You Working or Studying? (required)
WorkingStudying

How will the Aptis ESOL Test help you? (required)
Better Prospect at JobFurther Studying

LEARNER DECLARATION

I confirm that;
• I am not paying any amount towards the registration, examination and certification of Aptis ESOL.
• The information provided in this Registration Form is correct to the best of my knowledge;
• I understand that the information I have given is held by Grupo College London in its original and electronic and formats and that it will be used by Grupo College London staff for enrolment and reporting purposes.
• I am aware of the Privacy Notices in relation to my registration and I agree to share the information with relevant bodies

By ticking the box below
I consent to the conditions.