Get Further 23/24 Registration of Interest Form

Your Details

First Name

Last Name

Email address

Make sure there are no spaces at the end of the email address!

First Line of your address

Postcode

Date of birth

dd/mm/yyyy

Mobile number (this is so we can contact you to book your tuition lessons)

About You

What gender do you identify with?

What are your preferred pronouns?

Please indicate the option that best describes your ethnic group or background:

Have you ever recieved free school or college meals?

Have your parents/guardians (or, if you are over 18, you) ever been in receipt of benefits? (For example; Universal Credit, disability benefit etc)

The next few questions will help us to make sure that Get Further can provide the best possible support for you during the programme.

Do you consider yourself to have a disability or Special Educational Need?

How do you define your disability or Special Educational Need? (i.e. hearing impairment, Autism)

Is there any information about you that you would like your tutor to regarding supporting you in sessions, or accessibility requirements?

What is the main language that you speak at home?

Other language spoken at home:

Your Education

What is the name of your college / sixth form?

Your student ID / number (if known)

What level course are you studying this year?

Other Level Course

What subject is your course?

Other Course subject

What is the name of your course?

Which subject and qualification are you applying for support from a tutor for?

Have you previously attempted a GCSE in English?

What grade were you awarded when you previously attempted a GCSE in English?

Have you previously attempted a GCSE in Maths?

What grade were you awarded when you previously attempted a GCSE in Maths?

Study Supporter

Your Study Supporter is someone who you think is a good motivator, a parent/carer; sibling; mentor or friend. They will receive occasional updates and prompts from us to help you make the most of your tuition sessions.

Would you like to provide details of a Study Supporter (Details can be supplied at a later date)?

YesNo

Study Supporter First Name

Study Supporter Last Name

Relationship to your Study Supporter

If 'Other' please state:

Study Supporter Mobile Number:

Study Supporter Email Address:

Consent

I consent for sensitive personal information to be processed as set out in the Fair Collection Notice

Yes

Are you happy for Get Further to use your video/written feedback and/or photos for promotional purposes?

YesNo

Please let us know if you have any comments or questions regarding your participation in the Get Further programme:

After clicking on 'Submit', please wait for the Thank You page before closing the form.