EDT Course Enrolment Form 2020-2021

Your personal details

First name *

Last name *

Email

Confirm Email

Telephone

Date of birth *

Address Line 1 *

Address Line 2

City *

Postcode *

Number of years at present address *

Gender *

Male
Female
Other
Prefer not to say

Ethnicity

Is English your first language?

Yes
No

Course and Learner details

Course Code

How do you wish to be contacted about your learning? *

Phone
Email
Text
I do not wish to be contacted

Residential Status

Have you been a resident in the UK or a European Economic area for the past 3 years and have a National Insurance number? *

Yes
No

National insurance number

Qualifications

Do you have any previous qualifications? *

Yes
No

Would you like extra support with resources or your reading, writing, maths or English *

yes
No

Learning difficulties, disabilities and health issues

Have you got a disability? *

Yes
No

Do you have a Learning Difficulty? *

Yes
No

Do you have any other health issues or conditions (e.g. allergies, food disorder, other)? *

Yes
No

Employment status

Are you employed? *

Yes
No

Are you claiming any benefits? *

Yes
No

Your agreement with us

Please tick the boxes next to the statements below – they form your agreement with us and prove that you accept the terms of enrolment *

I have read and understood the Adult Learning Service privacy notice which sets out how you will process, share and store my personal data collected in this form
I have received information about the course as well as advice and guidance. I understand the aims, requirements, additional costs, entry requirements, suitability and implications of my choice of course