Start date

 
 
 
Please select a start date:
 
 
 
 
 
 

Personal details 

 
 
 
First name*
 
 
 
 
Preferred name*
 
 
 
 
Last name*
 
 
 
 
Email*
 
 
 
 
Telephone:*
 
 
 
 
Address line 1*
 
 
 
 
Address line 2
 
 
 
 
Address line 3
 
 
 
 
Town*
 
 
 
 
Postcode*
 
 
 
 
Country*
 
 
 
 
Please enter your date of birth: (dd/mm/yyyy) *
 
 
 
 
ULN (unique learner number if available):
 
 
 
 
 
 

Your qualifications

Please list your qualifications including CIH qualifications below, you must include:

  • Date studied
  • Name of qualification 
  • Level 
  • Grade (if applicable) 

PLEASE NOTE: Do not use any special characters (!,-&*|+=_) when listing your qualifications. 

 
 
 
Please list your qualifications (include date, subject, level and grade):
 
 
 
 
Please provide proof of your certificate/qualification.
 
 
 
 
Please provide proof of your certificate/qualification.
 
 
 
 
Please provide proof of your certificate/qualification.
 
 
 
 
 
 

Your career history

Please tell us about your employment history. If you are currently working in a voluntary position inhousing, please specify the organisation you work for and your role.

PLEASE NOTE: Do not use any special characters (!,-&*|+=_) when listing your career history. 

 
 
 
Your career history:
 
 
 
 
 
 

Access to assessment

*It is important that you read and understand the CIH learning and support arrangement.We will send you a form to sign and return to us as part of your application.

 
 
 
Do you consider yourself to have any disability or medical condition that would mean that you would need reasonable adjustments to support your studies?*
 
Yes
No
 
 
 
If you selected yes to needing reasonable adjustments, please provide more details:
 
 
 
 
Please tell us about any further information that you'd like us to consider:
 
 
 
 
 
 

Please select a payment method

 
 
 
Payment options:*
 
 
 
 

Invoice details

If you selected invoice to employer please complete the following details, if you selected Visa/Debit/Credit Card please go to the next page.

 
 
 
Employer
 
 
 
 
Employer address
 
 
 
 
Purchase order number:
 
 
 
 
Authorised by (print name):
 
 
 
 
 
 

Declaration by applicant

 
 
 
I certify that the information given in this form is correct and fully completed.*
 
I agree
 
 
 

Where the fees are paid by your employer or a sponsor, CIH may provide details of your progress to them if requested and where CIH deem appropriate.

 
 
 
Do you allow us to provide details of your progress to your employer? *
 
Yes, I agree
No, I do not agree
 
 
 
 
 
 

Please confirm you have read and understood our terms and conditions.

 
 
 
I have read and agree to the terms and conditions*
 
Yes
 
 
 

Data protection statement 

By submitting your details, you consent to our processing of your personal data in compliance with GDPR. We will only use your information to follow up on your submission. Your data won't be used for any other purposes without your explicit consent.

Your data will be retained only as long as necessary for the original purpose and you have the right to access, correct, delete, or restrict the processing of your personal data. Please review our Privacy Policy for a detailed understanding of our data practices.

 
 
 
Please state that you have read and understood the Privacy Policy*
 
True
 
 
 
Please tell us if you would like to stay informed about CIH membership:*
 
 
 
 
Please tell us if you would like to stayed informed about CIH products and services:*