Family Learning

Course Application

The Course

Course name

Dates

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

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.

Crèche

Do you need a crèche place for your child(ren)?

Yes No

Will you need crèche places for any children other than the one mentioned above?

Yes No

Name of child	Date of birth	Age

You will be asked to complete a crèche form prior to the start of the course. Please mention any information concerning your child(ren)'s allergies, likes/dislikes, potty training, using toilet, etc.

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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