Application Form

Please complete all sections of this online form.  You should also submit scanned copies of relevant qualifications, or be prepared to submit certificates of your qualifications at interview.  Please ensure that all information is accurate and can be verified through certification.  Please check all submitted information carefully, ensuring that your contact details are accurate.

    Which course are you applying for?*

    When do you want to start the course?*

    For CPD please specify the modules you wish to take

    First Name*



    Full Address*

    Date of birth*

    Contact number*

    Alternative number*

    Email address*

    Qualifications. GCSE (or equivalent) year, subject, grade*

    A Levels (or equivalent) vocational qualifications and apprenticeships, year qualifications, subjects and grades*

    Further education including university degree, diplomas, certificates, include year and award with other relevant information*

    Qualifications taken but not yet awarded (if applicable). Tell us when awards are due*

    This is a work based learning programme and you will be required to demonstrate that you have been trained and are competent in areas of ophthalmic practice outlined in the course programme. Your employer will need to agree that you will be provided with this training.

    Describe your employment history including positions held and relevance to this sector*

    Briefly describe your reasons for taking this course*

    Who will be paying your course fees?*

    Medical history: Do you have any medical conditions or disabilities?*

    Any additional comments or queries