Advanced Diploma in

STRUCTURAL ENGINEERING

Accredited by
Candidates will be assessed and need to demonstrate their experience and proof of identification and address.

ENROLMENT FORM AND LEARNING AGREEMENT

You are required to attach your updated CV and scanned copy of your education certificate (if you have any)
with this form. Your applications should be emailed to admission@theccm.co.uk

THE INFORMATION YOU SUPPLY ON THIS FORM WILL BE TREATED CONFIDENTIALLY.

Section 1. Candidate’s Details

Surname:       First Name:       Title:      

Address:      
     
     

Postcode:      
Date Month Year

Date of Birth:            

Home Telephone No:      

Mobile Telephone No:      

E-mail address:      

I would like to receive information from the College Yes No

on career development and other programmes.

I would like to receive information about Chartered Yes No

Membership (e.g. newsletters / phone calls).

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Advanced Diploma in
STRUCTURAL ENGINEERING

Accredited by
Section 2. Education Details (Please fill this section if you are not currently working in the industry)
Please detail your highest, most recent or most relevant qualification.

Full name of
     
School/College:

Address:      
     
     

Postcode:      

Course Title:      

Date From:      

Date To:      

     

Exam Results:

Section 3. Present Employment / Apprenticeships

If you are currently unemployed, please give details of your most recent employer. If you do not have any
relevant work experience, please leave this section blank.

Name of Employer:      

Address:      
     
     

Postcode:      

Job Title:      

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Advanced Diploma in
STRUCTURAL ENGINEERING

Accredited by
Section 4. Payment Plan

Fees
Please tick your preferred payment plan.

Total fee £2,856 x 2 years.

Monthly Payment Plan: £280 upfront fee and £280 x 23 months (Month 1 to Month 23, inclusive). Your
monthly payment will be taken as a direct debit through the debit or credit card which was used to
subscribe in Stripe.

Please note that paying in full works out at a lower price than the monthly payment plan.

Section 5. Reasonable Adjustments

By ticking this box, I confirm that I wish to inform the College at the time of this application that I intend
to apply for reasonable adjustments due to a disability or difficulty that may place me at a substantial
disadvantage in an assessment and/or learning situation.

Section 6. Declaration and Learning Agreement

To the best of my knowledge, the information contained in this application form, CV and certificates are true,
correct and complete. I understand that any misrepresentation may invalidate my enrolment to the course. I
have read and understand the Terms and Conditions of the enrolment linked here: https://theccm.co.uk/terms-
and-conditions/ . I accept and agree to all these Terms and Conditions.

By ticking this box, I confirm that I wish to access the College’s Moodle and live lectures immediately
and therefore within the cancellation period (please refer to Clause 9 of T&C). I acknowledge that by
accessing the College’s Moodle and live lectures within the cancellation period, I will lose my right to
cancel the enrolment and/or claim a refund.

By ticking this box, I confirm that I give permission to the CCM to process my personal data in
accordance with GDPR.

If you return this form electronically please add your electronic signature if you have one or add your name in
the signature field, this constitutes a legally binding contract.

Name of Applicant:      

     
Signature:

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