Part-time register interest
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 Call 01785 223 800
To register interest for this course complete the form. A member of the Enrolments team will be in touch.
  • Personal Details
  • Course Details
  • Qualifications
  • Employment
  • Additional Information
  • Declaration
Personal Details
Title
Forename(s)
Surname
Address
Town
County
Postcode Exceeded maximum number of characters.
Telephone (home)
Telephone (mobile)
Email address
Date of birth
Sex
Nationality
Ethnicity
Have you been permanently resident in the UK and/or the European Union in the last 3 years?
Yes     No
If not, what is your country of residence?
Course Details
Please enter the details of the course(s) you wish to take.
Course Code Course Title Course Year (1 or 2) Start Date Start Time
Qualifications Held
Please indicate the level of qualifications you currently hold:
Entry Level
Other qualifications below level 1
Level 1 (Less than 5 GCSEs at grades A-C, BTEC First Certificate)
Full Level 2 (5 or more GCSEs at grades A-C, BTEC First Diploma)
Full Level 3 (2 or more A levels, BTEC National)
Level 4 (First degree, HNC/HND, teaching qualification)
Level 5 (Postgraduate degree)
Other qualifications, level not known
 
Relevant Qualifications
If your chosen course has entry requirements in the part time prospectus, please list the relevant qualifications and experience to support your application:
Employment Details
Are you employed? Yes       No
Is your employer paying your fees? Yes       No
(If yes, you will be required to provide a letter from the employer to confirm and an invoice will follow later)
Are you on a work based learning apprentiship scheme? Yes       No
Please provide details of your employer/training provider/jobcentre:
Additional Information
Please answer the following questions, if you would like to discuss these with a member of staff please tick the relevant box at the bottom.
Yes    No Do you have a relevant (unspent) criminal conviction?
(If yes or unsure you will be required to provide details on form CSV8, available from the enrolment centre)
Yes    No Have you ever attended a course run by Stafford College previously?
If so, and you were using a different surname, please provide it here:
Yes    No Do you have a disability? (e.g. visual or learning impairment?
Yes    No Do you have a learning difficulty? (e.g. dyslexia)
Yes    No Do you have a health condition? (e.g. epilepsy, asthma, diabetes, arthritus etc.)
If you have answered yes to any of the above 3 questions, you will be required to fill out form CSV9 upon enrolment

Please tick this box if you prefer to discuss any matter confidentially with a member of our DHCA team.
Student Declaration
  1. I confirm that to the best of my knowledge the information given on this form is correct and complete.
  2. I have received information on my chosen course(s) and understand that, if required, I have the opportunity to discuss my choice(s) with an advisor.
  3. I give my consent to the College to pass on any personal information I have disclosed regarding any learning difficulty/disability, health condition or criminal conviction to relevent member(s) of College staff to help me with my studies.
  4. I understand that my enrolment may be subject to an assessment of risk by the College if I have disclosed a learning difficulty/disability, health condition or criminal conviction.
  5. I agree to abide by the terms and conditions of the Colleges Student Code of Conduct, which is included in the Student Handbook.
  6. I understand that College course fees are not generally refunded and that fees normally remain payable if I should withdraw from the course.
  7. I understand that if my course fees are not paid in full I will not be enrolled on a new course, until all outstanding debts have been paid.
  8. I give my consent to the college to the College providing reports on my attendance and progress at College if requested by my employer/sponsor including JobCentrePlus.
  9. I understand that the information I provide to the College on this form will be passed to the Learning and Skills Council (the LSC) which is registered under the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data but it also allows the Council to share information with other organisations for the purpose of administration, careers and other guidance and statistical/research purposes.
    • Please tick this box if you do not wish to be contacted by the LSC or its partners in respect of your views on the education or training you receive
    • Please tick this box if you do not wish to be contacted by the LSC or its partners about courses or learning opportunities relevant to you
I agree to the above statements. Date : 05/02/2012
Click here to:

Please fill out all the fields on the form making sure you complete all sections. Click on the coloured headings to switch to that section.

Once you have completed and checked your details press the submit button in the declaration tab.

If you experience any problems or have any queries with your enquiry please call:

01785 275 607

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General enquiry: 01785 223 800
Full-time enrolments: 01785 275 468
Part-time enrolments: 01785 275 607

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Stafford College, Earl Street, Stafford ST16 2QR

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