Family Learning

Course Application

The Course

Course name

Dates

(Please make sure these are the dates you would like to attend.)

Cost of course:

About You

Parent name

Address

Post code

Telephone

Home Mobile

E-mail

About Your Child (if applicable)

Name of child

Date of birth

Age

Other Information

Please answer the following questions as this will help us gain funding for you to do this course.

Are you on a low income or receiving benefits?

Yes No

Do you or your family have additional needs or have support from other agencies (e.g. health visitor/social worker)?

Yes No

Do you think you may need support with this course (e.g. visually/hearing impaired, learning difficulties)?

Yes No

(If yes, we will make contact prior to the course date to discuss this with you.)

Please list any literacy and numeracy qualifications you have achieved in the last 5 years.

How did you hear about us?

Please note that places on courses cannot be guaranteed. We will let you know whether you have a place on the course you have applied for TWO WEEKS before it starts.

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