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Course Registration Form

Lifelong Learning - STUDENT REGISTRATION FORM 2019 - 2020

Please complete and hand in to Nishkam Centre reception or email to learning@ncauk.org. Please note your place on the course can only be confirmed once payment has been made in full and subject to class size. Some course may be subject to a successful initial assessment.
Please complete all sections of this form in capital letters
1. Title Mr.Mrs.MissMs.Other
2. Surname
3. First name/s
4. Course Name
5. Gender MaleFemale
6. Date of Birth
7. Permanent Address Postcode
8. Telephone Number
9. e-mail Address
10. Can we contact you by email & text message? YesNo
11. Emergency Contact (if you are under 18 this must be your parent, guardian or carer)
Name Telephone
Address Relationship

Ethnic Origin        Bangladeshi       Indian       Kashmiri       Pakistani       Asian Other       Black African       Black Caribbean       Black Other         White       Sikh       Other Origin (Specify)
13. Please tick the box that applies to you, are you? EmployedUnemployedStudentRetired   Other
14. What is the highest level of qualifications that you already have?

Year Type of Exam Awarding Body Subject/ Qualification Grade Tutor/advisor Initial to verify
Please explain in a few words, why you wish to enrol onto this course and what your personal objectives are.

Data Protection Act 1998 – The information that you provide may be shared with the Learning Skills Council (LSC). The LSC is responsible for funding, planning and encouraging education and training for young people and adults in England and is registered under the Data Protection Act 1998.
I declare that the information I have given is correct. I agree to abide by centre regulations and to inform the centre of any changes in my address or status. I understand that if I break any of the rules in the Centre Code, Learning Agreement the IT User Policy I may lose access to the internet and computer networks and be subject to the Centre disciplinary procedure. I also understand that if I withhold any information which later found to have been detrimental to me or any other person at the Centre then I may also be subject to centre discipline procedure. I confirm that I have received information and guidance on the course/s I am enrolling on.
I agree the terms and conditions
Date :

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