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| Personal Details |
Title:
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If Other:
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First Name:
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Middle Name:
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Last Name:
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Date of Birth:
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Gender:
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Nationality:
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International Passport No:
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| Permanent Home Address |
Address 1:
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Address 2:
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Address 3:
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Zip Code:
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Country:
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Phone:
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Mobile:
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Address for Correspondence
Correspondence will be sent to your correspondence address, You must inform us if you address changes. |
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Address 1:
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Address 2:
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Address 3:
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Zip Code:
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Country:
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Phone:
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Mobile:
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| You must provide a personal active email address, this is essential for you to be kept informed about your studies. |
| E-Mail: |
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Please List your Educational Qualifications: Year, Awarding Body, Grade, Award
Please note you will be required to send to us a photocopy of your present qualifications |
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| Please indicate which degree or professional programme you are applying for: |
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Academic Degree Qualification
ICCE/BA, £5,500
ICCA/MA, £7,700
ICCF/PhD, £9,900
Professional LPCMC Qualification
ICCE, £2,900
ICCA, £4,500
ICCF, £6,800
Year of Entry:
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How do you intend to finance your study at LPCMC?
Give Details |
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Please give details if your study will be sponsored by other source:
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Work Place Details:
Name of Work Place, Full address of Work Place, Your Position and Department |
Name:
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Address 1:
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Address 2:
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Address 3:
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Zip Code:
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Country:
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Position
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Department
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Parents, Next of Kin, Spouse Details:
(if applicable) |
Full Name of Father:
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Father's Phone No:
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Full Name of Mother:
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Mother's Phone No:
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Full Name of Next of Kin:
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Next of Kin's Phone No:
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Full Name of Spouse:
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Spouse's Phone No:
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Checklist:
Please note before we can process your application we will need to be sent the following: |
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Photocopy of your present qualifications |
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Your recent Curriculum Vitae (CV) |
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Self Passport Photograph x2 |
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Admission Application form fee (Non-refundable) – £20.00 |
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Declaration:
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Applicant must read and sign the following declaration: |
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I certify that the statements made by me on this form are correct. I understand that the LPCMC reserves the right to withdraw any offer it may make should any statement in this application prove to be false.
I confirm that, if admitted, I will conform to all LPCMC Regulations.
I understand that LPCMC reserves the right to withdraw or alter any course at any point before the start or during academic year in which that course is due to be offered or has been offered.
(please tick)
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