NEW Student Record Form – Humanitarian | LLA Logistics Learning Alliance

PART 1: STUDENT NAME(S)

First / Given Name:

Please enter ONLY your First or Given Name *

Other / Middle Names & Last / Family Name:

Please enter any middle names along with your Last / Family name. *

Certificate Name:

Please enter your full name exactly as you would like it to appear on your certificate of completion at the end of your programme *

Preferred Name:

Please enter the name you would prefer us to use in our communications with you. For example your First or a Middle Name. *

Part 1: Confirmation

Check the details above are correct and the select the checkbox below before moving to the next section *

I confirm the above details are correct

PART 2: STUDENT PERSONAL DETAILS

Preferred Gender Pronoun

LLA aim to be as inclusive as possible and do not discriminate on the grounds of gender. Please enter the pronouns you would prefer us to use. This helps us to refer to you correctly and reduces the risk of causing offense in our communications.

Date of Birth

Please enter your date of birth. Please check to ensure this is correct as this will be part of any security checks that take place when communicating with our team. *

Additional Learning Support

Do you have any difficulties or disabilities that may affect your learning? *

NO
YES

If you have indicated that you have any difficulties or disabilities that may affect your learning you will be contacted by a member of our team in order for us to discuss your needs.

Job Role or Title

Please enter your current job role or title. *

Part 2: Confirmation

Check the details above are correct and the select the checkbox below before moving to the next section *

I confirm the above details are correct

PART 3: STUDENT ADDRESS

Postal Address:

Please enter your address. Please ensure this is correct, as this is where we will send any certificates.

Address line 1 *

Address Line 2

Town / City *

State / Region *

Postal / Zip Code *

Country *

Part 3: Confirmation

Check the details above are correct and the select the checkbox below before moving to the next section *

I confirm the above details are correct

STUDENT EMAILS AND TELEPHONE NUMBERS

Primary Email Address:

Please enter your primary email address. This is the email we will use during your programme. *

Email

Confirm Email

Personal Email Address:

Please enter your personal email address. This MUST NOT be your work or company email address. (Please Note: This might be the same as your primary email if you have used your personal email above as well.) *

Email

Confirm Email

Primary Contact Number:

Please enter your primary Telephone Number. This is the number we will use during your programme if we need to call you. (Choose your country code by clicking the flags). *

Personal Telephone:

Please enter your personal Telephone Number. This might be your home or mobile number. This SHOULD NOT be a work or company number. (Choose your country code by clicking the Flag. *

Part 4: Confirmation

Check the details above are correct and the select the checkbox below before clicking submit *

I confirm the above details are correct

NEW STUDENT RECORD FORM (H)

Please complete this Student Record Form for New Students

PART 1: STUDENT NAME(S)

First / Given Name:

Other / Middle Names & Last / Family Name:

Certificate Name:

Preferred Name:

Part 1: Confirmation

PART 2: STUDENT PERSONAL DETAILS

Preferred Gender Pronoun

Date of Birth

Additional Learning Support

Job Role or Title

Part 2: Confirmation

PART 3: STUDENT ADDRESS

Postal Address:

Part 3: Confirmation

STUDENT EMAILS AND TELEPHONE NUMBERS

Primary Email Address:

Personal Email Address:

Primary Contact Number:

Personal Telephone:

Part 4: Confirmation