Student Work Experience

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First Name *

Last Name *

Email *

Phone Number *

Address Line 1 *

Address Line 2 *

Postcode *

Gender *

Date of Birth *

Ethnicity *

If you have a disability, please state it here.

Are you a care leaver / in care? *

Are you working with the YOT or do you have a criminal record? *

Are you a carer? *

Are you homeless/ at risk of being homeless? *

Are you involved in substance misuse? *

What's is the highest level of qualification that you have achieved? *

What is the name of the school/institution where you received this qualification? *

Please describe your level of confidence in the following areas. *

What do I want to achieve from my work experience? *

What additional support will you need for your work experience? *

What are the best times to contact you before you start your work experience? *