UKeff Digital Skills Course – Registration Form

Please complete this short form to register for our Digital Skills course.

Name *

First

Last

Date of birth *

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Address *

Phone number *

Email *

Gender *

• Male
• Female

What is your status in the UK? *

• Refugee
• Asylum Seeker
• Humanitarian Protection
• British Citizen
• Other

What is your country of origin? *

What is your first language? *

How well can you speak English now? *

• I do not speak any English
• I can say and understand a few things in English
• I can speak and understand English but make mistakes

Do you have your own smartphone? *

• Yes
• No
• I share with someone

Do you have access to a laptop or computer? *

• Yes
• No

Do you have internet access (WiFi or mobile data)? *

• Yes
• No
• Sometimes

What would you like to learn? *

• Applying for Universal Credit or benefits
• Looking for a job
• Using email
• Filling in online forms
• Uploading documents
• Staying safe online
• Using a computer or smartphone
• Other

tick all that apply

How did you complete this form? *

• I did it by myself
• Someone helped me
• Someone did it for me

Is it safe for us to contact you? *

• Yes
• No (please tell us how to contact you safely)

us What my

If needed, how should we contact you safely?

I agree that UKeff can store my information and contact me about this course *

• Consent

Submit