Astronomy by Distance Learning Please complete both sides of this form and return it to Distance Learning the address opposite: Astrophysics Research Institute Tel: 0151 231 2900, Fax: 0151 231 2926 Twelve Quays House, Egerton Wharf, Email: firstname.lastname@example.org Birkenhead, CH41 1LD, UK. Which course(s) are you applying for? Please tick the box to the right of the course title and start month you wish to take. Exploring the Universe: April Planetary Atmospheres: July Exploring the Universe: October Astronomy for Teachers: Sep – Jan The Universe Through A Small Telescope: December Modern Cosmology: May The Universe Through A Small Telescope: June Universe Through A Large Telescope: July Galaxies : February The Science of Science Fiction: March Planetary Geology: November Stars: September Gamma Ray Bursts: May Extra-solar Planets: November (t.b.c.) FORENAME: SURNAME: ADDRESS: EMAIL: TELEPHONE: FAX: Date of Birth: Nationality: Country of permanent residence: If you have lived outside of the UK for any period, Month: Year: please state date of entry to the UK: Single module courses cost £130 for EU resident students, and £260 for non-EU resident students. Double module courses (Exploring the Universe and The Universe Through A Large Telescope) cost twice this amount. Please enter the total amount in the box to the right. £ These fees are inclusive of a bursary from Liverpool John Moores University. Fee amounts are valid for courses starting prior to August 2010. 1) If you wish to pay for your fees by credit or debit card then you will need to pay online. We accept Visa, JCB, Delta, Switch/Maestro and Access/Mastercard. When you submit your form to us, we will email you with your student number and details of how to pay. 2) If you are paying by cheque (pounds sterling only) then please make the cheque payable to Liverpool John Moores University and attach it to this form. 3) If you wish your company to be invoiced for your fees, then please attach a letter on letterheaded stationery from your sponsor confirming that they are paying the fees. Please note we cannot invoice non-UK addresses. 4) If you live in the UK and do not have a University degree and are in receipt of benefits or a state pension, you may be entitled to fee remission. Please tick the box for further details. Educational Qualifications Higher Degree (if any) Subject: University: Date of Award: Classification: Pre-Degree GCSE / A Level or equivalent: Please state if you have any disability which you think may affect your work on the course: Please state what type of computer and operating system you will be using to run the course CD-ROM (e.g. Windows VISTA, Mac OS X). If you have a telescope (a requirement for some courses) please state what type you have. Please state how you found out about our courses: Please state why you are interested in taking this course and if there are any areas about which you are particularly keen to learn: Signature I certify that the details on this form are correct. I agree to abide by the rules and regulations of Liverpool John Moores University, as displayed on the Campus-Wide Information Network (http://cwis.livjm.ac.uk/atoz/policy.asp). I accept responsibility for payment of tuition fees in the absence of any other form of sponsorship. Signature of Student Date Please tick the box on the right if you do not wish to be informed of similar courses run by Liverpool John Moores University of other affiliated universities. JMU is committed to equal opportunities and to ensure no discrimination takes place, please could you state your ethnic background if you wish, or else leave blank.
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