Part time enrolment form

Part Time Enrolment Form & Learning Agreement

Swindon College

2013/14

form or would like a large print version please contact Student Services T: 0800 731 2250 or 01793 491591 F: 01793 430503 | Please return to: Student Services, North Star Avenue, Swindon, SN2 1DY.

1. I would like to enrol on: Please use course title and code shown in the course guide.

Course Title

Course Code

Day

Fee in the course guide

Actual Start Date

Planned End Date

2. Residency Are you or your parent/guardian here on a student visa?

Yes  No  If yes, please specify country of residence: (Country Domicile) Have you been resident in England for 3 years prior to this enrolment?

Yes  No  If no, please specify country of residence: (Country Domicile) If you are under 19 at the start of your programme, has your parent/ guardian been resident in England for 3 years prior to this enrolment?

Yes  No  If no, please specify country of residence: (Country Domicile) 3. About Yourself Have you previously enrolled on a course at Swindon College?

No  Yes  ID Number:

Level 4 e.g. NVQ 4 or HNC or Professional Diploma Level 5 e.g. Foundation Degree HND or N VQ 5 Level 6 e.g. Award, Certificate, Diploma Degree Level 7 e.g. Award, Certificate, Diploma Masters Degree

Unique Learner Number:

Other (Please state):

Title (Mr/Mrs/Miss/Ms/Dr): Surname: Forename(s): Home Address:

Proof of ULN

Gender: Male  Female 

GP Surgery:

Have you been in full time education or training prior to this enrolment?

No  Yes  4. First & Second Emergency Contact Details 1. Name: Tel: Relationship: 2. Name: Tel: Relationship: 5. Employment/Unemployment Status.

In Paid Employment  Not in Paid Employment  Employed for less than 16 hours Looking for work and available to start work  per week  Not looking for work and/or not available to start work 

Unemployed for:

Less than 6 months  6-11 months  12-23 months  24-35 months  Over 36 months  In receipt of JSA  In receipt of ESA (WRAG) 

Please tick one box only: (must be completed) Entry Level e.g. Basic Skills Level 1 Level 1 e.g. NVQ 1 or GCSEs below Grade C or CSEs

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Level 2 e.g. NVQ 2 or 5 x GCSEs Grade A*- C or 5 x O Levels or 5 x GCSEs Grade 1 or BTEC/RSA 1st Diploma or GNVQ Intermediate Level 3 e.g. NVQ 3 or 2 or more A or AS Levels or BTEC National

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7. Do you wish to claim a reduction in fees?    Universal Credit - because you are unemployed and are required to undertake skills training

You must inform the College of any change

8. How will your fees be paid?

I wish to pay fee(s) totalling £ (please tick appropriate box) Cash (please do not send cash if enrolling by post)  Cheque (make payable to Swindon College)

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Credit/Debit Card 24+ Advanced Learning Loan

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Instalments these can be agreed for fees over £150. You pay a third when you enrol, followed by up to two further payments  Invoice to Employer (please enclose a letter of authorisation from your employer if they are paying your course fees)  I will claim my course fees back from my employer  Employer’s Name: and Address: (Activity code) Other, please specify: 9. How did you hear about the course(s)?

Please complete the following - it will help us in our future planning.

How did you find your part time course?  Press Advertising Employed for 16-19 hours per week   Website  Facebook  Visited college on general enquiry Employed for 20 hours or more  Friend/relative/colleague  Employer/workplace per week  Self Employed   Email  Job Centre Employed for:

20 hours or more per week’  Up to 3 months  4-6 months  7-12 months  In receipt of UC because you are unemployed More than 12 months  JSA (Job Seeker’s Allowance) and are required to undertake skills training 

In receipt of another state benefit other than JSA, ESA(WRAG) or UC 

Please specify:

GLH

This information is PRIVATE and CONFIDENTIAL.

Postcode: Years at Address: Date of Birth: Nationality: Home Tel: Work Tel: Mobile Tel: Email Address: National Insurance No: Are you currently enrolled at another educational institution?

No  Yes  If yes, please enter the institution: GP Name :

Waiver

ESA (Employment Support Allowance) WRAG (Work Related Activity Group) UC (Universal Credit)

Other, please state: Swindon College may occasionally send you information about courses, events and new developments. Please tick here if you do not wish to receive this information 