Level 3 Award in Awareness of Dementia and long term conditions 3565-31 To successfully complete this City & Guilds course you are required to: Complete this application form yourself Attend all three classroom days and participate in tutorial support Completion of workbook (in own time, much of it between classroom dates) to required standard Submission of workbook (four weeks after last classroom day) Please complete and return by 23 February 2018 to: Samantha Loughnane, Vocational Programmes Coordinator Section 1 – Personal Information DATE(S) OF PROGRAMME 14th & 27th March and 24th April 2018 FULL NAME NAME FOR CERTIFICATION (Block capitals) DATE OF BIRTH GENDER EMAIL OWN HOME TEL MOBILE TEL EMPLOYER MANAGER EMAIL/TEL ADDRESS FOR CORRESPONDENCE INFORMATION ABOUT CURRENT ROLE Please tell us your job title: How long have you been working in this job? Please write a paragraph to tell us how your role contributes to the dementia care delivered in your organisation:
Level 3 Award in Awareness of Dementia and long term conditions 3565-31 To successfully complete this City & Guilds course you are required to: Complete this application form yourself Attend all three classroom days and participate in tutorial support Completion of workbook (in own time, much of it between classroom dates) to required standard Submission of workbook (four weeks after last classroom day) Please complete and return by 23 February 2018 to: Samantha Loughnane, Vocational Programmes Coordinator Section 1 – Personal Information DATE(S) OF PROGRAMME 14th & 27th March and 24th April 2018 FULL NAME NAME FOR CERTIFICATION (Block capitals) DATE OF BIRTH GENDER EMAIL OWN HOME TEL MOBILE TEL EMPLOYER MANAGER EMAIL/TEL ADDRESS FOR CORRESPONDENCE INFORMATION ABOUT CURRENT ROLE Please tell us your job title: How long have you been working in this job? Please write a paragraph to tell us how your role contributes to the dementia care delivered in your organisation: