Enrolment Form

1. Personal Details

Surname or Family Name
First or Given Names
Record your name exactly as you wish it to appear on your Certificate
Nationality

2. Title (please tick)

Mr
Mrs
Miss
Ms
Dr
Other (state)

3. Your Contact Information

Correspondence Address
Country
Post Code
Telephone (including STD Code)
Mobile
Email

4. Next of kin

Name of Next of Kin
Relationship
Correspondence Address
Country
Post Code
Telephone (including STD Code)
Mobile
Email

5. Employer's Details

Name of Sponsor (if sponsored)
Name of Company
Correspondence Address
Country
Post Code
Telephone (including STD Code)
Fax
Email

6. Name of Course you are applying for

  Course title
Write your first choice course here
Write your second choice course here
State the month and year you want to begin your study

7. How did you hear about this college (please tick)

Internet		Newspaper (state where)
Word of Mouth		Hot Courses
Radio		Other (please state)
Recommendation (state their full name)

8. Qualifications Gained (List all qualifications with the most recent first)

Dates	Institution	Course	Level (i.e. Degree, Diploma, A Level, O Level)	Grade Achieved

9. Special Needs

Please tell us if you have any special needs:

Tick at least one box

I do not have any disability/special needs Mental Health difficulties
Wheelchair user Heart Condition
Visual impairment Diabetes
Hearing impairment Epilepsy
Speech impediment English not first language
Learning disability (i.e. dyslexia) Other Condition/s not listed

10. Please insert the names of two people who we can approach as referees (at least one of these should be an academic referee)

11. Supporting Statement

Please write a short supporting statement about yourself and your reasons for wishing to come on a particular course in the space provided below. In particular, tell us:

1. Why you have chosen the course
2. What relevant skills, knowledge and experience you have
3. Your future career plans (if known)

Please carefully read the course information in the prospectus to establish how much fees are due to be paid. In order to enrol, you need to fully complete this form, sign below and send it to us (either by post, by email, by fax or in person) together with your fees to this address:

Conditions of Enrolment and Payment

By signing this form I accept the Trans-Atlantic College conditions of enrolment.