Learner Application Form

Learner Details

Full Name *

Email Address *

Telephone Number *

Please select which course/s you are interested in *

Independent Domestic Violence Advocate (IDVA)Independent Stalking Advocacy Specialist (ISAS)

Place of Work *

Current Work Role *

Please list any previous work experience you believe is relevant to the qualification

Please list any previous qualifications and training *

Please outline below any special assessment requirements that you feel could apply to you. (This could, for example be an issue that comes within the disability discrimination requirements of the Equality Act or a language requirement) *

In relation to the above please outline the type of support and help that would be most useful to you to ensure that you are not disadvantaged *

Funding Details

How will the qualification be funded? *

Self fundedFunded by current employer

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