Workshop date Please select your chosen date Please select... Wednesday 10 June
Thursday 11 June
Applicant details Title (optional) Please select... Mr Ms Miss Mrs Mx
Surname
Forename(s)
Previous name (if applicable) (optional)
Home address
Postcode
Contact telephone number
Contact email address
Emergency contact details Emergency contact
Emergency contact telephone number
Employer/workshop fee information Organisation (optional)
Job title
Work email address
If a place on the selected workshop is available, it will be reserved. This will only be confirmed once a purchase order for the workshop fee has been provided.
Invoice address (optional)
Postcode (optional)
Contact person (optional)
Contact telephone number (optional)
Email address for invoice (optional)
PO number (if currently available) (optional)
Disclosure information Do you have any additional requirements? The information you provide will be treated confidentially and will not affect judgements concerning your academic suitability for the course. (optional) Please select... Yes No
If yes, please specify (optional)
Are you happy to work on pigs trotters and shoulders? Please select... Yes No
Equal Opportunities Monitoring As part of its equal opportunities policy, Birmingham City University carries out regular monitoring of student enrolments by gender, ethnic origin and disability. Provision of information on ethnic origin is voluntary, but we hope you will agree to provide it to assist us in the implementation of our equal opportunities policy.
Please select appropriate boxes below.
Gender (optional) Please select... Male Female Non-binary Prefer not to say Information refused
Ethnic origin (optional) Please select... 10 White
13 White – Scottish
14 Irish Traveller
15 Gypsy or Traveller
16 White - Other British
19 Other White background
21 Black or Black British – Caribbean
22 Black or Black British – African
29 Other Black background
31 Asian or Asian British – Indian
32 Asian or Asian British – Pakistani
33 Asian or Asian British – Bangladeshi
34 Chinese
39 Other Asian background
41 Mixed - White and Black Caribbean
42 Mixed - White and Black African
43 Mixed - White and Asian
49 Other mixed background
50 Arab
80 Other ethnic background
90 Not known
Disability (optional) Please select... A. No disability
B. You have a social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder
C. You are blind or have a serious visual impairment uncorrected by glasses
D. You are deaf or have a serious hearing impairment
E. You have a long-standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
F. You have a mental health condition, such as depression, schizophrenia or anxiety disorder
G. You have a specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
H. You have a physical impairment or mobility issues, such as difficulty using your arms or using a wheelchair or crutches
I. You have a disability, impairment or medical condition not listed above
J. You have two or more impairments and/or disabling medical conditions
Declaration