Enrolment Form

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					Enrolment Form
You may also enrol by telephone on 01594 838400 (except for FREE courses).
Please complete the form in BLOCK CAPITALS. One form to be completed for each person.
Please check whether you are eligible for a reduced fee (see pages 5 and 6).
Photocopied forms can be used. (Evidence of benefits is required in all cases)

 First Name ________________________________                  I have lived in the UK or another European Union

 Last Name ________________________________                   Country for at least three years.    Yes        No

 Title __________ Date of birth ______________
                                                              The college is committed to ensuring that all
 Gender:       Male       Female                              students have equality of opportunity. To help
 Address __________________________________                   us monitor and support you, please complete
                                                              the following section by ticking the relevant box
  ____________________Postcode ____________
                                                                  White British               White & Black
 Home Tel    ________________________________                                                 African
 Daytime Tel________________________________                                                  White & Black
 Mobile Tel ________________________________                      Asian Other
                                                                                              Mixed Other
 Email   ____________________________________                     Black African
                                                                  Black Caribbean
                                                                                              White Irish
 EMERGENCY CONTACT                                                Black Other
                                                                                              White Other
 Name ____________________________________________                Chinese
 Telephone ________________________________________               White & Asian

 Do you have any physical or learning disabilities     Yes        No
 If yes please tick the relevant boxes below                                LEARNING DIFFICULTIES

     Disabilities                         Emotional behaviour                   Moderate
     Visual Impairment                    Mental health difficulties            Severe
     Hearing Impairment                   Temporary disability                  Dyslexia
     Disability affecting mobility       Profound complex                       Dyscalculia
                                         disability                             Autism Spectrum
     Other physical difficulty
                                          Multiple Disabilities                 Multiple
     Other Medical conditions
     e.g. Epilepsy, Asthma,               Other                                 Other
  If you wish to discuss your needs confidentially please contact the Disability Officer on 01594 838401

 Please enter the details of the course(s) you would like to study:

 1 Course Title ______________________________________________ Location ___________________________

  Start Date ___________ End Date ___________ Day _________ Time _________ Cost £___________

 2Course Title ______________________________________________ Location ___________________________

  Start Date ___________ End Date ___________ Day _________ Time _________ Cost £___________

 3 Course Title ______________________________________________ Location ___________________________

  Start Date ___________ End Date ___________ Day _________ Time _________ Cost £___________
How to enrol
Enrolment Form
    Are you employed?      Yes      No                                PREVIOUS EDUCATION/
 Does can enrol
Youthis course relate to your employment?        Yes        No
                                                                      Please tick the box showing
by: describe any state benefits you currently receive.
                                                                      your highest qualification
                                                                      (please see the list of
 This may
Post affect your fees.                                                qualifications on page 44 of the
 Are you fill in the
Pleasein receipt of income based benefits or tax credits?             This information is compulsory
                                                                      for anyone enrolling on a FREE
adultname the benefit(s).
          enrolment                                                   course. If you do not complete
form located at the of a person in receipt of income
 Are you an unwaged dependants
                                                                      this information, it could delay
                                                                      your enrolment.
 based of this
back benefits or tax credits. Please name the benefit(s).
                                                                            No qualification (Level 0)
brochure. Return it
                                                                            Entry level
 Please tick if to: Royal
Freepost you fit any of the statements below:
 (This may affect your fees. Evidence of benefits is required).
Forest of Dean                                                              Level 1
       I am enrolling on a Basic Skill Literacy or Numeracy course.
College, Five Acres,                                                        Level 2
      This is my first full Level
Freepost (GL272) 2 course and I am aged 19+                                 Level 3
      This is my
Coleford, first full Level 3 and I am aged 19-25                            Level 4
      I am aged 16, 17 or
Gloucestershire, 18                                                         Level 5
GL16 7JT including                         You cannot enrol               I    Cheque (with
  Please write yourpay-
all relevant                               on
                      payment details here: free courses over             bankers
                                                                      GUIDANCE                card)
                                                                      This course guide gives a brief
ment.                                      the __ __ __
  Card number: __ __ __ __ __ __ __ __ __phone. __ __ __ __                  made courses available.
                                                                      description of thepayable to
                                                                      In addition it is possible to seek
IfIssue No:are claimingdate: ____ In Person £ ________
    you ________ Expiry               / ____ Amount:                         ‘Royal Forest of
                                                                      further advice and guidance from
aIfconcessionary fee cheque payable to:
     paying by cheque please make
                                                                             Dean College’
                                                                      the Learner Services team and Adult
  ‘Royal Forest of Dean College’      At the Learner                  Guidance Service. If the College is
                                                                           I Credit/Debit card
or FREE course you                                                    found liable for giving incorrect
                                      Services depart-                advice, the compensation will only
must also enclose a
  Cheque no: _____________________________ Amount: £ ________
                                                                      be up to the cost of the course fee.
                                      ment, Five Acres                All students attending physical
  This form your returned
copy ofshould beproof to the College Freepost address
  (no stamp required)                 Campus. We are                  education and associated classes are
(Please see page ….                                                   advised to inform their tutors if they
  ROYAL FOREST OF DEAN COLLEGE, Five Acres,every week-
for details).
                                      open FREEPOST (GL272)               Adult
                                                                      have a history of any illness, are
  Coleford, Gloucestershire, GL16 7JT                                 pregnant, receiving medical attention
                                      day between 9am-                    Community
                                                                      or taking any form of drugs.
Phone                                 5pm (4.30pm on a                    Leisure Courses
   STUDENT enrol over                 Friday).                        CHECKLIST
                                                                          This guide includes
                                                                      Before submitting this form
  I agree to abide by
                       01594 Charter, Dean College Terms and
the phone on the College Forest ofthe College Computer
                                         At Class                     please check that you have; for
  Code of Practice and the Royal                                          all ACL courses
838400. on the college website Information
  Conditions                                                        Enclosed copies of
                                      At the first class,
  I provide on this enrolment form will be used in accordance       2010/11. ACL
                                                                    benefit entitlement
  with the Dataclaiming
If you are       Protection statement on the receipt.
                                      subject to availabili-        Courses enrol on a
                                                                    Enclosed a cheque for
  I confirm the information provided on this form is correct.
a concessionary fee                 ty, Adult                       term byamount basis
                                                                    the correct term

you must also send
 Signed: ______________________   Date: ____________ Classes
                                                                    only. the Student
                                                                            Therefore you
a copy of your                      only.                           will not be able to
proof (Please see                                                   enrol on courses for
page …. for                         Payment:
                                                                    the whole year in
  Instalments   __________________________________ Refund ____________________
details).                           You can pay by:                 July.
  Invoice Company ______________________________ Invoice No. ________________
                                    I Cash                          Enrolment dates for