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? YesNo

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 / 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 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) YesNo

Type of wheelchair / Electric / Manual

Marketing Data

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

Local Doctors SurgeryLocal 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