New venture creation: application

Open Programme Application Form

ABOUT THE PROGRAMME

Your chosen programme

Promotional Code

Where did you find out about this programme?

Please specify if other

ABOUT THE APPLICANT

Title

Family Name

First Name

Known as

Emergency contact person and phone number

Do you have any special dietary requirements? If so, please list them here.

Do you have any special access needs? If so, please list them here.

Gender

Nationality

APPLICANT CONTACT DETAILS

Telephone

Mobile / Cell

2nd Email (or Assistant)

Street

City

Country

Zip / Post Code

APPLICANTS CAREER DETAILS

Occupation

Other job title please specify

Company

Company Size (number of employees)

Sector / Industry

Years' Experience

Briefly describe your responsibilities within the organisation

Briefly describe your learning objectives

L&D DIRECTOR DETAILS (OR EQUIVALENT)

Please complete this section if you are a HR or L&D head/director completing this application on behalf of the applicant because the company is sponsoring this application.

Name

Job Title

Telephone

INVOICING

If you are offered a place on the programme, an invoice will be issued once you have accepted our offer.

If you wish this invoice to be addressed and sent to someone other than yourself (e.g. your Finance department, HR manager etc.), please complete the information below. Alternatively, you can pay online in the City, University of London e-store.

Please select your payment method:

Send an invoice to me personally at the address provided in this applicationSend an invoice to another person as specified below (please provide correct email address)I prefer to pay online using the e-store

Invoicing Details:

FAO	Email
Telephone	Purchase Order No.
Company	Street
VAT number (EU based only)	City
State/Province	Zip/Postcode
Country	Notes (if any)

Please complete the details below to confirm your consent for us to contact you.

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to keep you informed with relevant information, including events,

scholarships and information on your chosen programme of interest to

support your application and decision-making. You will have the option to

unsubscribe at any time.

By ticking this box, you are choosing to remain unsubscribed from

our mailing list.

In processing your personal data to respond to and follow up on your enquiry, we will

do this securely and only use the information for your chosen purposes. We will never

sell, rent or lease it to 3rd parties. Please read our full privacy notice here. To talk to

us about how we use your information or report a concern please email

DataProtection@city.ac.uk.

TERMS & CONDITIONS

Please read our full terms and conditions here.

By ticking this box, I confirm that I have read, and agree to the terms and conditions.

Contact Information