ENROLMENT FORM

Complete the form below and send it to us using the "Submit" button below. We will then contact you to arrange payment and provisionally enrol you on your chosen course. Once we receive payment, we will then register you with the Open College Network, allocate a suitable tutor to you and send you course material.

   Mr 1  Mrs2   Ms 3   Other 4 

 

 

The Following Information is Voluntary  and is used to monitor the degree to which members of the Open College Network are meeting their stated objective to widen educational and training opportunities to under represented groups. Information may be shared with partner organisations for the purpose of preparing statistics. Please complete the appropriate boxes  below.

   Gender:    Male  Female 2                    Do you have a disability? Yes   No  

                                                                       If "Yes" Do you require support?   Yes    No                

 Ethnic Origin : Chinese 1       Indian  2    Pakistani  3     Bangladeshi  4      White  5      

                      Black African 6    Black Caribbean  7     Black Other 8     Other Asian 9    Not Known 10  

 Are You: Employed Full Time 1      Employed part Time 2    Self Employed 3  Registered Unemployed  4 

               Unwaged 5         Full Time Student 6