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 partin course activities? YesNo
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 Collegecourse in the past? Yes No
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 / Priority1 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 receiveconfirmation 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 £2.50for a return journey will bepayable ½ termly in advance.
- There is an additional material cost for practical courses such as art and drama @ £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) YesNo
Type of wheelchair / Electric / ManualMarketing Data
How did you find out about these courses? (Please tick all applicable)
Local Doctors SurgeryLocal Library Residential Home Received in post
Gloucestershire County Council
Other (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 meet3 or 4 times during the year)
Yes No
If you need further information please telephone 01242 534915 or email:
Signature ______Date: ______
NationalStarCollege
Ullenwood Manor Tel: 01242 527631 Fax: 01242 222234
Cheltenham email Website:
Gloucestershire GL53 9QU