Adult and Community Learning

Registration Form

Name:
Address:
Post Code: / Telephone number: / Email:
Date of Birth / Details of Disability

Do you need support to take part in course activities? Yes r No r

If YES, please provide your own care/support worker details:

Name of Support Worker: ______

Address of their Employer: ______

______

Contact Telephone Number: ______

Have you attended a National Star College course in the past? Yes r No r

If Yes, please provide brief details of courses and year.

COURSES: please record below up to 6 courses that you would like to register an interest.

Code / Course / Priority
1 being the highest / Day / Term

Helpful information

·  Courses will only run if sufficient learners enrol. You will be notified if a class is cancelled.

·  A Registration fee is payable per course at the rate of £25 per term. This fee must be paid when you receive confirmation of booking details.

·  College transport maybe available please contact the ACL office for further information, however we cannot always guarantee this service. A contribution toward transport costs of £2.50 for a return journey will be payable ½ termly in advance.

·  There is an additional material cost for practical courses such as art @ £1.50, cookery @ £2.50

TRANSPORT

If you are unable to arrange your transport independently would you like to request transport on the limited NSC Adult Part-time Learners’ transport? (£2.50 per return journey payable in advance) Yes r No r

Type of wheelchair / Electric / Manual

Marketing Data

How did you find out about these courses? (Please tick all applicable)

Local Newspaper q Radio q

Received in post q Residential Home q

Advertising on National Star College buses or coach q

Other q (give details)

Participation in College Forum

If you were invited, would you be willing to participate in a College Adult Learner’s Forum to represent the views of other adult learners? (This would meet 3 or 4 times during the year)

Yes r No r

If you need further information please telephone 01242 534915 or email:

Signature ______Date: ______

National Star College

Ullenwood Manor Tel: 01242 527631 Fax: 01242 222234

Cheltenham email Website: www.natstar.ac.uk

Gloucestershire GL53 9QU