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Personal Details
Address
Contact Details
Emergency Contact
Equality & Diversity
Education & Employment History
Are you unemployed and in receipt of JSA or ESA (WRAG)? Yes No
Local Education Authority
Requirements
We provide additional learning support, technology and appropriate dedicated accommodation for learners with a disability or serious medical condition, a learning difficulty or mental health issues, who qualify for it. Please declare below and bring evidence of your Personal Independence Payment or a medical note when you attend for your course. This information will be treated as confidential.
(Please note that all of our bedrooms are non-smoking rooms)
If you would like to share a room, please agree with someone else who is attending the course to share a room and write their name and type of room you would prefer (Twin, double, family) below
Dietary Requirements
Children
For those unable to make their own childcare arrangements, we provide a limited number of places for children aged over 6 months and upto 11 years and 11 months. Please note children will share rooms with parents, and there is no guarantee of a childcare place being offered. Places will not be allocated for your children unless all details are supplied.
Please give details of any disability, registered or unregistered, or medical condition, of which you think the Children's Centre should be aware:
Additional Information
Have you previously studied at Northern College? Yes No
Where did you hear about Northern College? Newspaper I am a Former Student Careers Guidance/Library Word of Mouth Referred by another college Employer Community Centre/Group Northern College Leaflet Found on Web Other
Comments?
Learning Needs
Please spend a few minutes completing this questionnaire. It will help us to plan the course. We want to make sure that, as far as possible, we have taken all your educational needs into account. If you would like advice, help or support to complete this, please phone the Northern College Registry on 01226 776010, they will put you in touch with the course tutor.
Thankyou for taking time to complete this questionnaire. This will enable us to make your visit and learning experience as welcoming as possible
To complete and confirm your application has been sent
to the Registry Office
please press the 'Submit' button
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