Asset Skills
2 The Courtyard
48 New North Road
Exeter
EX4 4EP
info@assetskills.org

Energy Advice (Home) Qualification Pilot in Northern Ireland

February to May 2011

Learner Application Form

* Indicates required information

First Name:*

Surname:*

Home address:*

Post code:*

Contact number/s:*

Email:*

Employer:

Address:

Post code:

Contact number/s:

Email:

Nature of business or profession:

Current job title:

Brief summary of educational history - with particular reference to training, education and qualification in energy assessment or advice:*

Declaration: I hereby apply for a place on this pilot course and confirm that (please tick boxes below):

I hold the qualification/s listed above

I shall devote all the time required to complete the course and obtain the two qualifications

(If relevant) I have the support of my employer in undertaking the learning

(If relevant) I shall undertake initial top up training

Notes: Prospective learners who are NOT qualified as Domestic Energy Assessors will have to undertake top up training at a (heavily subsidised) cost of £500 at the beginning of the course.

This form should submitted by 5.00pm on Thursday 20 January 2011.

All valid applications will participate in a ballot.

If you would like to complete the form and return by email to pstott@assetskills.org, please click here to download the word document.

If would need any help or further information please email pstott@assetskills.org or call 01392 456825.

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