On Line Enrolment Form

Trade Union Studies Courses
2011 - 2012

Which course do you want to enrol to?

This form is intended for learners on our TUC online programmes. Class based learners will complete a paper enrolment form on day one of the course. To apply for a course please follow this link. However, if you have a disability or learning difficulty completing this form before the course may help us to meet your access needs as soon as possible.

TUC Equality Diploma Online

I've applied for a course and wish to inform you of my access requirements

I'm enrolling at the college to meet my access needs

Personal Details

Title
Your Full Name
Address Line 1
Address Line 2
City / Town
County
Post Code
Date of Birth
e-mail address
Home Phone Number	-
Work Phone Number	-
Mobile Phone Number (the college may contact you by SMS)	-
Trade Union
Employer's Name (& Plant)
Department & Job Title

Country of Residence

Have you been a permanent resident in the UK or another European Union Country since 31st August 2008?
Yes
No

If no please complete all of the following details:-

State date of entry into the UK

Please indicate if your passport indicates your current status is:-

Asylum Seeker
Indefinite Leave / Full Refugee
Exceptional / Humanitarian / Discretionary Leave to Remain
Overseas Learner

Ethnic Origin

To help us monitor equal opportunities please indicate how you would best describe your origin:-
White - British
White - Irish
White - Gypsy or Irish Traveller
Other white background
Mixed - White & Black Caribbean
Mixed - White & Black African
Mixed - White & Asian
Other Mixed Background
Indian
Pakistani
Bangladeshi
Chinese
Other Asian background
African
Caribbean
Other Black/African/Caribbean background
Arab
Other

Prior Attainment

None
Entry Level
Level 1
Full Level 2
Full Level 3
Level 4
Level 5
Other, Level not known

Individual Needs

If you have a learning difficulty or disability, please help us by giving as much information as possible. This is confidential and will only be used to arrange the necessary support for your needs.

Disability or Health Issues

No disability
Visual impairment
Hearing impairment
Disability affecting mobility
Other physical disability
Medical condition (e.g. epilepsy)
Emotional/behavioural difficulties
Mental health disability
Temporary disability
Profound complex disabilities
Asperger syndrome
Multiple disabilities
Other (please specify)

Learning Difficulties

No learning disability
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Other specific learning difficulty
Autism spectrum disorder
Multiple learning difficulties
Other (please specify)

Have you any additional medical conditions and/or support needs which the college should be aware??

Yes (Please specify)
No

Please Check The Boxes Below as Confirmation

I understand that the college is bound by the terms of the Data Protection Act and that my data will be stored in accordance with these regulations
I understand that this online enrolment form will be used by the college in lieu of a form with my signature

To complete the enrolment process a copy of this information will be sent to the address you have entered above for you to sign and return to East Riding College.

Please use the space below to give us any other information

East Riding College
Trade Union Studies Centre
24-30 St James Street
Hull
East Yorkshire
HU3 2DH

01482 382545