To: ICSC(L) Admin Co-ord, ICSC(L), JSCSC, Faringdon Road ... - DOC by pLdevf2h


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To: ICSC(L) HQ Administrator, Army Division, JSCSC, Faringdon Road, Shrivenham, Wilts
SN6 8TS. Military email: DEFAC-ICSC(L) HQ Admin
Tel. 01793 314440/ 96161 4440          Fax. 01793 314455/ 96161 4455

                                     ICSC(L) STUDENT REGISTRATION FORM

Please complete the form fully in BLOCK CAPITALS then post, fax or email it to the
ICSC(L) HQ Administrator to arrive no later than 31 JAN 10. (If any of these details
change after you have submitted the form please contact ICSC(L) HQ Admin.)

                                                        PERSONAL DETAILS
Current Rank           Initials:                  Surname:                                             Regt/Corps:

Service Number:        Decorations/Post                 Forenames:                                          Preferred Name:

                       (Not Campaign Medals)
Gender:                Date of Birth:           Nationality of passport/s held:       Marital Status (Single/Married/Civil Partnership):

    Type of Commission:

                                    I am attending Course :                    7A                 7B

  (Include LE if applicable)        Dietary Restrictions (not preferences):

                                    (i.e. Vegetarian, vegan, Muslim, food allergies etc.)

Please tick one of the following boxes to indicate whether you require a room in the Officers’ Mess (SLA), will be applying for a MQ
(MQ), or wish to live in privately-owned accommodation (Private):
                       SLA (see also Note 1)                         MQ                      Private (see also note 2)

Note 1: If single and applying for SLA, please indicate whether or not this will be your principal residence, where you will be
keeping all of your belongings.      Yes           No
Note 2: Officers wishing to live in private accommodation must obtain permission in writing from COS Army Division at the
above address.
                                                             FAMILY DETAILS

Forenames of Spouse/Civil Partner (if applicable):                                                  Preferred Name:

Child 1 D.O.B ______               Name ___           ___________________________________________
Child 2 D.O.B ______               Name___            ___________________________________________
Child 3 D.O.B ______               Name ___           ___________________________________________
Child 4 D.O.B ______               Name ___           ___________________________________________
Child 5 D.O.B ______               Name ___           ___________________________________________

 In order to assist nursery planning, we would be grateful if you would indicate (no commitment) whether you anticipate placing any of
your children in a nursery (please give numbers of children in brackets): Not at all:         Part time:            Full time:

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                                           PROTECT-STAFF (When Completed)

                                                       CONTACT DETAILS
    This information is required to enable us to contact you between now and when the course starts, particularly when we
                                            distribute the Director’s letter in Feb 10.

Dates from and to:                                                    Tel:

Appointment title (If Work Address) :                                 Email:
                                                                      (the address we are most likely to get you on before your arrival)
Full Unit title (If Applic):
                                                                       Preferred means of contact (tel./ email/ post):


Dates from and to:                                                   Tel:

Appointment title:                                                   Email:

Full Unit title:
                                                                     Preferred means of contact (tel./ email/ post):

                                               SUMMARY OF OPERATIONAL TOURS

                           Iraq                                 Sierra Leone                          Northern Ireland

                           Afghanistan                           Bosnia                               United Nations

                           Kosovo                      Other:

                                                MILITARY SERVICE (last 6 years only)
                               (Appointments which will have been completed by the time you join ICSC(L))

         ADC/ADJT Appointments                 _           _________________

        SO3 Appointments:                      _           __________________                 Appt and rough date

        SO2 Appointments:                      _           _________________                 e.g: SO3 ISTAR HQ 4 Bde 06 - 07
                                                                                                  Adjt Old College RMAS 07 - 08
        Sub-Unit Comd Appts:                   _           _________________

                                                   OTHER: (continued on next page)
    Year                Theatre                     Appt                                       Unit                          Op name if

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                                         PROTECT-STAFF (When Completed)


                                      JOTAC                   AJD                 Year of AJD:

     Bachelor Degree                                                  Postgraduate Qualification
     Subject:                                                         Subject:

     University:                                                      University:

     Qualification title (e.g. BA(Hons)):                             Qualification title (e.g. MA:

     Class awarded:

                                                        VEHICLE DETAILS
            This information is required in order for the necessary car passes to be produced prior to your arrival.

Vehicle 1
  Registration:                                                        Make:

  Model:                                                               Colour:

Vehicle 2
   Registration:                                                        Make:

   Model:                                                               Colour:

We would like to pass some of the information you have supplied on this form to other parts of the Defence
Academy for the purposes of administering post-ICSC(L) Employment Training. If you are NOT content for us to
do this then please put a cross in the box:
We would like to use some of the information you have supplied on this form to generate a course social list. If you
are NOT content for your details to be used and distributed in this way then please put a cross in the box:

If there is any other information you would like to give us please use this space to do so:

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