Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Birth *

MM

DD

YYYY

Ethnic Origin *

Black or Black British - Caribbean

Black or Black British - African

Other Black background (British or otherwise)

Mixed - White and Black Caribbean (British or otherwise)

Mixed - White and Black African (British or otherwise)

Mixed - White and Asian (British or otherwise)

Other mixed background (British or otherwise)

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Other Asian background (British or otherwise)

White-British

White - Irish

Other White background

Chinese (British or otherwise)

Other (British or otherwise)

No information Given

Please indicate the day/times you wish to attend. *

You can indicate more than one.

Monday 13.15 - 17.15

Monday 17.30 - 21.30

Thursday 17.30 - 21.30

Bursary *

Please indicate here if you wish to apply for a bursary place. Please only apply for a bursary place if you are experiencing financial hardship. You will not be required to submit any financial information. Please note that bursary places are limited and will be allocated on a first come first served basis.

I would like to apply for Bursary support

I do not require Bursary support