Completion Form Please enable JavaScript in your browser to complete this form.Full Name as per passport (First Middle and Last name) *FirstMiddleLastCandidate Reference/Enrolment Number *Date of Birth *Start date of the course *Home Address *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)Viet NamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryNationality *AfghanAlbanianAlgerianAmericanAndorranAngolanArgentinianArmenianAustralianAustrianAzerbaijaniBahamianBahrainiBangladeshiBarbadianBelarusianBelgianBelizeanBenineseBhutaneseBolivianBosnianBrazilianBritishBruneianBulgarianBurkinabéBurmese (Myanmar)BurundianCambodianCameroonianCanadianCape VerdeanChadianChileanChineseColombianComorianCongolese (Congo)Costa RicanCroatianCubanCypriotCzechDanishDjiboutianDominicanDutchEast TimoreseEcuadoreanEgyptianEmiratiEnglishEquatorial GuineanEritreanEstonianEthiopianFijianFilipinoFinnishFrenchGaboneseGambianGeorgianGermanGhanaianGreekGrenadianGuatemalanGuineanGuyaneseHaitianHonduranHungarianIcelandicIndianIndonesianIranianIraqiIrishIsraeliItalianIvorian (Côte d’Ivoire)JamaicanJapaneseJordanianKazakhKenyanKuwaitiLaotianLatvianLebaneseLiberianLibyanLithuanianLuxembourgishMalagasy (Madagascar)MalawianMalaysianMalianMalteseMauritanianMauritianMexicanMoldovanMonégasque (Monaco)MongolianMontenegrinMoroccanMozambicanNamibianNepaleseNew ZealanderNicaraguanNigerianNorwegianOmaniPakistaniPalestinianPanamanianParaguayanPeruvianPolishPortugueseQatariRomanianRussianRwandanSalvadoranSaudi ArabianScottishSenegaleseSerbianSeychelloisSierra LeoneanSingaporeanSlovakSlovenianSomaliSouth AfricanSouth KoreanSpanishSri LankanSudaneseSurinameseSwazi (Eswatini)SwedishSwissSyrianTaiwaneseTajikTanzanianThaiTogoleseTonganTrinidadian or TobagonianTunisianTurkishTurkmenUgandanUkrainianUruguayanUzbekVenezuelanVietnameseWelshYemeniZambianZimbabweanEmail *Phone *Did you pay your course full fees? *YesNoIf your fee is not paid yet, you will not be certified. Tick 6 Units that you have completed for Level 3 Diploma in Adult Health and Social Care *Mandatory - Responsibilities of a Health and Social Care Worker (updated) / Introduction to HSC (Old)Mandatory - Effective Communication in Health and Social Care (updated)/ Communication (Old)Mandatory - Person-centered ApproachesOptional - Health PromotionOptional - Diabetes AwarenessOptional - Stroke AwarenessOptional - Dementia AwarenessOptional - Mental Health Awareness Optional - Disability Awareness Optional - Effective Handling of Information in Health and Social Care Settings Declaration *I am happy that the Cambridge Management and Leadership School is taking all reasonable steps, so I’ll be certified with the highest standard qualification.I understand that my result is subject to the quality assurance of assessment.I hereby confirm that I have successfully completed all required units for the course and that all information I have provided is true and accurate. I understand that the OTHM – awarding & accreditation body will verify my participation, assessment records, and authenticity of my work. I accept that the certificate issued to me is subject to the institution’s policies, quality assurance procedures, and accreditation standards, and that failure to comply with any of those may result in certification being withheld, suspended or withdrawn. I agree that my details (including name, date of completion, and certificate number) will be shared with the accrediting body and other regulatory or audit authorities as required by law or accreditation rules. I confirm that I will abide by any usage conditions of the certificate (such as correct wording, no misuse or falsification) and understand that misrepresentation of the certificate may constitute an offence under applicable legislation and may lead to disciplinary, civil or criminal action. Submit