Al-Ghazali Multicultural Centre

Are you eligible? * You need to be able to tick ALL THREE answers to be eligible for our FREE distance learning courses

I live within Liverpool city council boundaries

I am aged over 19

I am currently unemployed/economically inactive/retired?

Which courses you are interested in?*

First Name *

Last Name *

Gender *

Male Female

Date of Birth *

National Insurance number *

must have national insurance number to be eligible

Addess *

Postcode *

Contact Number *

Email Address *

Ethnicity*

What is your highest qualification?

Have you got a disability?

This could be a physical, emotional and/or learning disability or difficulty

Yes

No

Unemployment Status * Please select the most appropriate unemployment status for your circumstances

Looking for work

Not looking for work(economically inactive/retired)

How long have you been unemployment for? *

Less than 6 months

6-11 months

12-23 months

24-35 months

Over 36 months

What benefit are you claiming? *

Job seeker allowance

Employment support allowance(ESA)

Another state benefit

Universal credit

State Pension

How do you prefer to be contacted about your learning?

Phone

Text

Email

consent*

Yes

By checking this box, I confirm that the details I have provided are correct and I agree to share these details with Alghazali center and that Alghazali center may process these details in accordance with it's GDBR privacy.

Signature *

By typing your name in this box below you will be deemed to have signed this document

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