Part Time Enrolment 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
  Other (please state) 

Gender
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?  
Have you lived in the UK/EU for three or more years?  

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?

Do you have a Home Office Letter?

Do you require a Student Visa?

* 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.







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?

If yes, please give details


Do you require assistance with this while you are at College?
If yes, please give details


Do you have a disability?
If yes, please give details


Do you require assistance with this while you are at College?
If yes, please give details

Please give the name(s) of any Support Workers/Key Workers who can give us more information:-



















We will also contact your previous school for information which will enable us to plan any extra support for you.

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







If other, please specify

Employment Details
Employer Role A19



What is your employment status prior to starting course?




If Other, please state 

If you are employed, please select one of the following




What is the highest level of qualification you have obtained prior to starting the course?
     Level Examples
 
Literacy/Numeracy
 
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
5 GCSE's (O Levels)at Grades A-C, 1 GNVQ Intermediate, First Diploma, 1 A Level, 2/3 AS Levels, NVQ2
2 or more A Levels, 4 or more AS Levels, AVCE, Access to Higher Education, National Certificate/Diploma, ESOL, NVQ3
Teaching Qualification, HNC, HND, Advanced Diploma, First Degree, NVQ4
Higher Degree, NVQ5, High Level Professional Qualification
Please state:

Disclosure

Northampton College is an inclusive College and we are keen for all students to be well cared for. We therefore ask all learners to declare if they have any unspent criminal convictions. If you answer yes, you will be asked to provide further details. This does not automatically affect your admission but allows the College to undertake a risk assessment and provide support as appropriate.

Do you have any unspent criminal convictions?

If yes - please give the name of your contact at either Probation Service or Youth Offending Team:

We may contact the above person to enable us to complete a risk assessment


Marketing and Research
Please tick the boxes if you do not wish to be contacted about other courses or learning opportunities:
Please tick the boxes if you do not wish to be contacted for surveys and research:

Send your enrolment request