EES (Mediprospects E-Enrolment System)

Personal Information

Learner Name *

Gender *

Male

Female

Non-Binary

Prefer not to say

Date of Birth *

Age on 31/08/25 (years)

National Insurance *

Your council / Local Authority

Mobile Number *

Home Telephone Number

E-mail Address *

Current Residence

Street Address *

Address Line 2

City *

Post Code *

Country *

How long have you been living in UK or EEA/EU?

Year *

missing year.

Month

Total Length of Stay (in years) *

How would you like us to contact you? *

Select All

Mobile

Home Telephone

Next of Kin Details *

Next of Kin Contact Number: *

Relationship

Employment

Are you employed?

Length of employment:

Hours worked per week *

Company Name

Employer Designation

Employer Address

Street Address

Address Line 2

City

Post Code

Country

Employer Contact No.

Employer Email Address

Career Goal

What kind of work are you looking for? Please add here in order of reference. Please add three in order of preference

Information Advice & Guidance

Programme

Are you currently enrolled on a course?

Do you fall in to any of these categories below:

Apply For (Course) *

Educational Background

Highest level of qualification achieved

Please provide details of GCSE

Subject

Grade Achieved

Year

*If you do not have GCSE please give details of Equivalent

Upload Certificates

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Maximum file size 5MB

Eligibility

Mediprospects is committed to equality of opportunity and values diversity. The Centre has a legal requirement to collect diversity data from learners. This information will be used for monitoring purposes only and will be treated as confidential.

Active Benefits

Are you currently in receipt of benefits?

How did you find out about us?

How we use your personal information

The General Data Protection Regulation (GDPR) has replaced previous data protection laws as of 25 May 2018. This Regulation is designed to harmonise data protection rules across all EU member states, strengthen individual privacy rights, and establish a clear legal framework for handling personal data.

By signing below, you are giving your consent for Mediprospects to process your personal data solely for the purpose of assessing your eligibility to enrol on a course.

If your application is successful, we will retain your application form for seven years, as required by legal or contractual obligations. After this period, your information will be securely destroyed.
If your application is unsuccessful, we will retain your information for one year before securely destroying it.

You have the right to withdraw your consent to the processing of your personal data at any time. Please note, however, that doing so may impact your ability to apply or be considered for a course.
For more details, please review Mediprospects website at: www.mediprospects.ac.uk

Declarations

Privacy Policy *

I have read and agree to The Privacy Policy

Terms & Condition *

I have read and agree to The Terms and Conditions

Student Learning Agreement

In order to process Your application, you must read and sign this agreemnt.

I hereby give my consent to Mediprospects to process my personal data for the purpose of assessing my eligibility to enrol on a course.

The information provided in this form is true and accurate to the best of my knowledge.
I have received and understood the information provided in the Mediprospects Privacy Policy and Terms and Conditions.
I have received sufficient information about the course I am applying for, including its content, duration, and any associated costs.
I agree to abide by the rules and regulations of Mediprospects during my course of study.
I understand that my personal data will be processed in accordance with the General Data Protection Regulation (GDPR) and Mediprospects' Privacy Policy.

Signature

Upload Signature

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Date

Application form 2025/26