Astronomy by by maclaren1


									                                 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:                             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:


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

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:

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
( 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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