Rila Prospect Form

Request Information Form

Please enter your Professional Registration Number

Physical or other Disabilities or medical conditions including any which might necessitate special arrangements or facilities.If you have a disability or special needs please tick the box next to statements below that are most appropriate to you.
you have dyslexia
you need personal care support
you are blind/partially sighted
you have mental health difficulties
you are deaf/hard of hearing
you have an unseen disability eg. diabetes/epilepsy/asthma
you are a wheel chair user/have mobility difficulties
you have a disability or special need not listed

Please attach a passport size photo

If you are a non-native speaker of English please give details of your highest English Language qualification (eg IELTS, TOEFL)

White British
White Irish
Any Other White background
Mixed White and Black Caribbean
Mixed White and Black African
Mixed White and Asian
Any Other Mixed background
Any other Asian background
Black or Black British
Other Black groups
Any other Ethnic Group

I confirm that, to the best of my knowledge, the information given in this form is correct. I have read the course details and agree to abide by the conditions set out

I agree to receive emails from Rila Institute of Health Sciences

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