Part Time Enrolment Request Form

Please note - you should only complete this form and submit it to us if you are going to be paying the course fee and any other related fees in full by credit or debit card. We shall then call you within 5 working days to confirm the booking and take your card details. If you are claiming any discount please come in to the college with your original benefit letter. If you wish to discuss fees or discounts please call us directly on 0845 300 4401.

Learner Details

Surname Forename(s) Title MrMrsMsMiss   Other (please state)  Gender MaleFemale Date of Birth (dd/mm/yyyy) Home Address Town Postcode Next of Kin Name (for emergencies) Relationship to You Next of Kin Contact Tel No Second Next of Kin Name (for emergencies) I agree to details relating to my application being shared with the next of kin I have named. Relationship to You SecondNext of Kin Contact Tel No National Insurance Number

Your Daytime Tel No Your Evening Tel No Your Mobile Tel No Your E-Mail Address Do you live in Hostel Accommodation?   YesNo Have you lived in the UK/EU for three or more years?   YesNo If less than three years, where did you you live before this? What is your Nationality? What is your normal country of domicile? If you are not an EU national, please answer the next three questions. Are you an Asylum Seeker? Yes*No Do you have a Home Office Letter? Yes*No Do you require a Student Visa? Yes*No * Asylum Seeker/Home Office/Visa documentation must be shown at enrolment

Please write in the programme details here
Course Title	Day	Time	Enrolment Code	Start Date

Equal Opportunities

Northampton College has a policy to promote Equal Opportunities in all its work. Please assist us to monitor whether this policy is working by selecting the category to which you see yourself belonging. 41 - Bangladeshi42 - Chinese32 - White Irish 39 - Indian37 - Mixed White & Asian34 - White any other White background 40 - Pakistani36 - Mixed White & Black African33 - Gypsy or Irish Traveller 43 - Any other Asian background35 - Mixed White & Black Caribbean47 - Arab 44 - African38 - Mixed any other mixed background98 - Any other 45 - Caribbean31 - White British/Welsh/Scottish/Northern Irish

Additional Learning Support In order to assist your learning, Northampton College will attempt to make all reasonable adjustments for learners with learning difficulties and/or disabilities. Do you have a learning difficulty? YesNo If yes, please give details Do you require assistance with this while you are at College? YesNo If yes, please give details Do you have a disability? YesNo If yes, please give details Do you require assistance with this while you are at College? YesNo If yes, please give details

How did you hear about the College Please help us to improve the effectiveness of our marketing by telling us what first prompted you to enquire about these courses Previous Learner  Phoned College   Guidance Event  Directory   Employer  Flyer   Directory in Letterbox  Word of Mouth   Radio  Internet   Newspaper  Other   If other, please specify

Employment Details Employer Role A19 Learner is enrolled and released by the employer to study The employer has not released the learner to attend Learner is attending dedicated employment provision None

What is your employment status prior to starting course? EmployedStill at School Full Time EducationUnemployed Self EmployedNot Economically Active Other If Other, please state  If you are employed, please select one of the following Your employer has no involvement in your study You are released by your employer to attend college You are not released by your employer to attend college You are attending a programme specifically set up for your employer

What is the highest level of qualification you have obtained prior to starting the course?
Level	Examples
None
Entry Level Qualification	Literacy/Numeracy
Other Qualifications below Level 1
Level 1	5 GCSE's (including O Levels), Grades at D-G (or fewer than 5 grades at A-C), CSE below Grade 1, GNVQ Foundation, NVQ1
Level 2 Full	5 GCSE's (O Levels)at Grades A-C, 1 GNVQ Intermediate, First Diploma, 1 A Level, 2/3 AS Levels, NVQ2
Level 3 Full	2 or more A Levels, 4 or more AS Levels, AVCE, Access to Higher Education, National Certificate/Diploma, ESOL, NVQ3
Level 4	Teaching Qualification, HNC, HND, Advanced Diploma, First Degree, NVQ4
Level 5	Higher Degree, NVQ5, High Level Professional Qualification
Other Qualifications, level not known	Please state:

Send your enrolment request