Part Time Enrolment Form & Learning Agreement Swindon

2009/2010
Please complete this form in BLOCK CAPITALS in ballpoint pen.
College
If you have any difficulties in completing the form or would like a large
print version please contact Student Services on 0800 731 2250

Please return to: Student Services, North Star Avenue, Swindon, SN2 1DY. T: 0800 731 2250 / 01793 491591 F: 01793 430503

1. I would like to enrol on: Please use course title and code shown in the course guide. Office use only

Course Title Course Code Day Fee in Actual Expected Waiver

the course guide Start Date End Date

2. About Yourself 5. Widening Participation

Have you previously enrolled on a course at Swindon College? If any of the following applies to you please tick the appropriate box:
Yes  ID Number: No   Asylum Seeker  Refugee
Documentation checked: date:
ULN Proof of ULN  Statutory education interrupted  Traveller
Office use only
 Full time carer  In or recently left care
Title (Mr/Mrs/Miss/Ms/Dr): Gender: Male  Female 
Surname: 6. Support for Learning
Forename(s): Swindon College wishes to support you in your learning and
Home Address: recognises that some students have a disability or a learning difficulty.
Postcode: This information is completely confidential and does not affect your
application to Swindon College. If you feel you may require support
Date of Birth: Nationality:
during your learning, please specify
Home Tel: Work Tel: e.g.Visual Impairment, Dyslexia:
Mobile Tel: Are you in receipt of Disabled Student Allowance? 
Email Address:
National Insurance No: 7. Equal Opportunities Monitoring
Have you been resident in England for three years prior to this enrolment? Completion is voluntary. The information supplied will be used only
Yes  No  If no, please enter your previous country of residence: for statistical purposes and will be treated as confidential.
Please tick the group to which you think you belong:

Are you currently enrolled at another educational institution?
 Black African  Mixed White & Black African
Yes  No  If yes, please enter the institution:
 Black Caribbean  Mixed White & Black Caribbean
 Bangladeshi  Other Asian  Black Other
 White British  White Irish  White Other
3. Emergency Contact Details  Indian  Mixed White & Asian  Chinese
Name:  Pakistani  Mixed Other  Other
 Do not wish to provide
Tel: Relationship:
4. Previous Qualifications
8. Do you wish to claim a reduction in fees?
What is your highest current qualification? Please tick one box only: This information is PRIVATE and CONFIDENTIAL.
No qualifications  I wish to claim reduced course fees because I receive the following benefit(s):
Entry Level e.g. Basic Skills   Job Seeker’s Allowance (Benefit office stamp only)
 Working Tax Credit with TC602, income less than £15,267
Level 1 e.g. NVQ 1 or GCSEs below Grade C or CSEs
 Pension Guarantee  Credit Housing benefit
below Grade 1 or BTEC First Certificate or GNVQ Foundation   Asylum Seeker  Income support
Level 2 e.g. NVQ 2 or 5 x GCSEs Grade A*- C or 5 x O Levels or 5 x  Council tax benefit  Employment support allowance
GCSEs Grade 1 or BTEC/RSA 1st Diploma or GNVQ Intermediate   I am the unwaged partner or child of someone receiving the above.
Level 3 e.g. NVQ 3 or 2 or more A or AS Levels or BTEC National
Please bring your benefit book to College so that a photocopy of the
Diploma or RSA or CGLI Advanced Certificate or GNVQ Advanced  relevant details can be attached to this form, or contact Student Services
Level 4 e.g. NVQ 4 or Degree or HNC/HND or Professional Diploma  for a form to take to your Benefit Office. You must inform the College of
Level 5 e.g. NVQ 5 or Masters Degree  any change which could affect your fee reduction.
P.T.O
Not known 
9. How will your fees be paid? 12. Student Declaration
I wish to pay fee(s) totalling £ (please tick appropriate box) Please read this section carefully. If there is anything that you do not
understand, please contact Swindon College Student Services before signing
Cash (please do not send cash if enrolling by post)  the declaration.
Cheque (make payable to Swindon College)  I confirm that I have received information and advice about my choice of
Credit/Debit Card (please fill in details below)  learning programme through the Part Time Course Guide and/or Swindon
College staff.
Instalments these can be agreed for fees over £90.You pay
a third when you enrol, followed by up to 2 further payments  As a result of this information and advice, I state that:
I understand the implications of my choice of learning programme.
Invoice to Employer (please enclose a letter of authorisation
from your employer if they are paying your course fees)  I understand the entry requirements of each learning aim within my chosen
learning programme.The learning programme suits my needs,
I will claim my course fees back from my employer  progression and personal ambitions. A check was carried out to see if
Employers Name previous experience or qualifications could be counted towards the course.
and Address: I know what additional support (practical, child care, tutor, financial) is
available in order to help me complete the course.
Staff Development unit (Activity code)  I understand that refunds will only be given in exceptional circumstances.

Other please specify:

Student Services assessment was provided by:

10. Credit/debit card details Tutor: Signed:

Card No: I confirm that the information provided to Swindon College is correct.
Last 3 digits of security number on the back of card: I agree to abide by the regulations, procedures and policies of Swindon
 Debit card  Credit card* College. I agree to inform the College in writing of the following:
Any change in circumstances that may affect my fee status eg. receiving
Cardholder’s name (as on card): benefit. Any medical condition which may affect my performance on the
Valid from date (if the card has one): learning programme or in College activities.
Expiry date: Issue number: I understand that all courses are subject to change in light of enrolments
and patterns of attendance. It is my intention to complete the programme
I agree to my credit/debit card being charged as above. and register for qualifications if applicable. The College reserves the right
*There will be a 50p charge for credit cards to use work generated by learner for publicity purposes up to 5 years from
Signature: Date: enrolment. I understand this form is a learning agreement between Swindon
College and myself.
11. How did you hear about the course(s)?
Please complete the following - it will help us in our future planning. Signature: Date:
How did you get your copy of the part time course guide?
 Through the door   From Library or other venues
Thank you for enrolling at Swindon College.
 Emailed/phoned to request it  Visited college on general enquiry
 From employer/workplace  Newspaper article/advertising
 Friend/relative/colleague  Previous course tutor Data Protection Act 1998 – The information you provide will be passed to the Learning and Skills Council (the
LSC). The LSC is responsible for funding, planning and encouraging education and training for young people and
 College web site adults in England and is registered under the Data Protection Act 1998. The information you provide will be shared
Other, please state: with other organisations for the purpose of administration, careers and other guidance, and statistical and research
purposes. Other organisations with which we will share information include, the Department for Children, Schools
Swindon College may occasionally send you information about courses, and Families, the Department for Innovation, Universities and Skills, Connexions, Local Authorities, Higher
events and new developments. Education Statistics Agency, Higher Education Funding Council for England, educational institutions and
organisations performing research and statistical work on behalf of the LSC or its partners. The LSC also administers
Please tick here if you do not wish to receive this information the learner registration service (LRS) which will use your information to create and maintain a unique learner
If you require your information to be altered please write to: number (ULN). The LSC is also a co-financing organisation and uses European Social Funds from the European
Union to directly or indirectly part-finance learning activities, helping develop employment by promoting
College Information Services, Swindon College, North Star Avenue,
employability, business spirit and equal opportunities, and investing in human resources. Further information
Swindon, SN2 1DY. about partner organisations and the ULN and what they do, may be found at www.lsc.gov.uk/providers/Data/help/
dataprotection.
MIAP Standard Fair Processing Notice
At no time will your personal information be passed to organisations for marketing or sales purposes. From time to
The Managing Information Across Partners (MIAP) service is operated by the time students are approached to take part in surveys by mail and telephone, which are aimed at enabling the LSC
Learning Skills Council (LSC) for learners aged 14 years and over and learners and its partners to monitor performance, improve quality and plan future provision.Tick this box if you do not
registering for relevant post-14 qualifications. wish to be contacted by the LSC or its partners in respect of surveys and research.The LSC values your views on the
education or training which you receive, and will use these to help bring about improvements for learners in
MIAP offers a Learner Registration Service to allocate Unique Learner
England 
Numbers (ULNs) which enable the individual to access a Learner Record
Service. Your ULN is on the front of your Learning Agreement. The Learner The LSC or its partners may wish to contact you from time to time about courses, or learning opportunities relevant
Record Service will offer the learner the facility to access their participation to you. Please tick here if you do not wish to be contacted about courses or learning opportunities
and achievement data via a website and to share this with other by post 
organisations and individuals where permission is granted. For learners under the age of 19 as at 31 August in the Academic year of the start of your programme, your parents
The MIAP service will allow those organisations listed on section 537A of the and guardians may be consulted with regard to your attendance. If you object to information and data being given
to your parents/guardians, please inform the Director of Student Services in writing within four weeks of the start
Education Act (www.miap.gov.uk) to use the Unique Learner Number as a key of the course. If you object to the College publishing your results please inform the Director of Student Services in
to sharing participation and achievement data in a consistent and approved writing within four weeks of the start of the course.
manner, promoting good information management practice. The information you provide on this enrolment form will be entered onto Swindon College’s student record system.
All organisations that will have access to the information you provide are The form will be held in a locked filing/archive room for a period of seven years before being destroyed. If you
registered under the Data Protection Act 1998. At no time will your personal require access to your enrolment records whilst at Swindon College, please contact the CIS Data Team on freephone
0800 731 2250.
information be passed to organisations for marketing or sales purposes.
Individuals can opt-out of sharing participation and achievement data with Swindon College may process personal information obtained from this form or other data from you or other people
while you are a learner. This information will be processed for any purposes in connection with your studies, for
those organisations listed in section 537A of the Education Act. health and safety reasons and any other legitimate reason.
Details of opting-out of data sharing can be found at www.miap.gov.uk or by
telephoning the MIAP helpdesk on 0845 6022589.