Sefton Community Learning Service Enrolment Form

Sefton Community Learning Service Enrolment Form

Course Name

Course Start Date (format dd/mm/yy)

Surname

Forename

Title

Date of Birth (format dd/mm/yy)

Gender

National Insurance Number

Permanent Home Address - Address Line 1

Address Line 2

Town / City

County

Postcode

Email Address

Phone Number 1 (eg Mobile)

Phone Number 2 (eg Home)

Have you been a permanent resident during the whole of the last three years for purposes other than education in the UK, EU or EEA?

Have you previously gained any qualifications?

What is your ethnicity?

* This indicates mandatory fields