On Line Enrolment Form

Trade Union Studies Courses
2010 - 2011

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 Health and Safety Diploma Online

TUC Employment 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

Term time accomodation type?

With Parent/Guardian
Own or rented accommodation

Are you in receipt of full time carer's allowance?

Yes
No

Have you attended East Riding College (or taken a course online with us)?

Yes
No

Do you have any criminal convictions or cautions? (Non motoring)?

Yes
No
If Yes, you will be required to complete a criminal convictions form, unless you have already provided one for this year.

Country of Residence

Have you been a permanent resident in the UK or another European Union Country since 31st August 2006?
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:-
Asian/British - Bangladeshi
Asian/British - Indian
Asian/British - Pakistani
Other Asian/British
Black/British - African
Black/British - Caribbean
Other Black/British
Chinese
Mixed - White/Asian
Mixed - White/Black African
Mixed - White/Black Caribbean
Other Mixed Background
White - British
White - Irish
White - Other White Background
Other

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

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