47 Course Information: 01924 789111 General Information: 01924 789789 Title: Surname/ Family Name: Forename( s): Date of Birth: Address: Post Code: Telephone Number: eMail Address: Nationality: Country of Domicile: Mobile Number: UK Entry Date: If you have lived outside the UK. Please write the title of the course( s) you are interested in enrolling for: Course Title: Campus: Page Number: Where there is more than one session advertised, please indicate preferred session: First Choice: Please enter any qualifications or experience you have which you feel are relevant to the course you are applying for: Day: Time: Second Choice: Day: Time: Depending on which course you choose, it may be necessary for you to have an interview with a specialist tutor prior to enrolment. If an interview is necessary, please indicate the best time available for you. It would be helpful if you could state more than one. Dates( s) or Day( s): Morning: Afternoon: Evening: It is in your interest to tell us about any additional support needs you may have so that we can provide you with reasonable adjustments at College. If any of the following apply to you please tick the box and our Additional Support team will contact you: diagnosis of dyslexia, a medical condition, a learning difficulty, dyspraxia, a disability, ADHD, autistic spectrum disorder, mental health issues, are Deaf or hard of hearing, are blind/ visually impaired, mobility difficulties or have other support needs. I do not have any additional support needs. N. B. By completing the above form your name will be added to the course list as an interested applicant. You will then be sent details of how to enrol and secure your place. The College reserves the right to withdraw any advertised class for which insufficient numbers of students enrol and to close any class if low numbers attending make it no longer viable. The LSC administers the learner registration service ( LRS) which will use your information to create a unique learner number ( ULN). The College will use your ULN in our systems and will also have access to your participation and achievement information. You can opt- out of sharing your participation and achievement information and details of how to do this can be found at www. miap. gov. uk. The information you provide is subject to the Data Protection Act 1998. It will be used for the College business proposes to process your application and will only be disclosed to the appropriate College staff. I agree to Wakefield College processing the personal data contained in this form to progress my application and for various administrative purposes. I do have additional support needs. Signature: Date: # # Application Form for a Part- time Course Completed forms should be returned to: Registry, FREEPOST LS5943, Wakefield College, Margaret Street, Wakefield WF1 2BR.

General Telephone: 01924 789789 Course Information: 01924 789111 Minicom: 01924 789270 General Enquires: info@ wakefield. ac. uk Course Information: courseinfo@ wakefield. ac. uk Website: www. wakefield. ac. uk All Wakefield College Prospectuses are available in text format on the College website. Alternative formats are available on request, such as large print, Braille, British Sign Language video, audio tape and CD Rom. Phone 01924 789228 for details. Wakefield Campus Margaret Street Wakefield West Yorkshire WF1 2DH Thornes Park Campus Thornes Park Wakefield West Yorkshire WF2 8QZ skillsXchange Thunderhead Ridge Castleford West Yorkshire WF10 4UA