Part Time Application

Course Name

Start Date

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Start Date

Campus

Mode of Study

Fees

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Funding Code

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UIO ID

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Campus Digit

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Enquiry Type

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Language Preference

Learner Type

I am an individual learner wishing to book this course

I am an employer booking this course on an employee鈥檚 behalf

We need some extra information from you

You may be eligible for a discount on tuition fees! To proceed with your booking, we just need a few extra pieces of information from you.

Please provide correct and full information on all questions. Failure to do so would invalidate your Course Booking and result in your booking being removed from our system. For more information please read our Fee Policy.

Are you an asylum seeker or have you been living in the UK for less than 3 years?(Required)

No

Yes

Date of Birth(Required)

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Age for Page Conditional Logic

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Text for Page Conditional Logic

Are you currently enrolled with Coleg Gwent on a Full-Time or Work-based learning Programme?(Required)

Yes

No

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Text for Page Conditional Logic

First Name(Required)

Last Name(Required)

Email(Required)

Telephone(Required)

Postcode(Required)

First Name*(Required)

Last Name*(Required)

Employer/Business Name

Address Lookup

First line of address*(Required)

Second line of address

Town or city

Locality or district

Postcode*(Required)

Email address*(Required)

Confirm Email address*(Required)

Telephone*(Required)

Marketing Preference

Post

Email

Text

Phone

We鈥檇 like to keep you informed about new courses, events and offers from the Coleg Gwent group. Please select how you鈥檇 like to hear from us:

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Language Preference

English

Welsh

Which language would you prefer to receive future communications in?

You can change your mind and opt out at any time via our Privacy Policy.

LEARNER DETAILS

Information for Employers:

Do you have 6 or more learners you'd like to book on to this course? If so, funding may be available. We also offer bespoke courses to meet your training needs.

To find out if you're eligible or to discuss your bespoke training needs contact our Employer Engagement Team on 01495 333777 or email employers@coleggwent.ac.uk with your requirements.

Additional Learners

First Name* (Required)

Last Name* (Required)

Gender* (Required)

Date of Birth* (Required)

Address

Town or City

Locality or District

Postcode

If you are booking for multiple employees, please add their details below:

Total Costs

Course Summary

Start Date

Campus

Mode of Study

Fees

Payment Options(Required)

Invoice/PO

Cheque

Card (offline payment)*

Booking confirmation will be finalised on receipt of payment.

*PLEASE NOTE: We do not accept American Express and Diners Club. Please contact our Student Recruitment team on 01495 333777 to make a payment over the phone.

P.O Number

BILLING DETAILS

billing_details

Use details given on previous page

First Name*(Required)

Last Name*(Required)

Address Lookup

First line of address*(Required)

Town or city

Locality or district

Postcode*(Required)

Telephone*(Required)

Email address*(Required)

CANCELLATION POLICY

Please read our Terms and Conditions to submit your booking request.

PRIVACY POLICY

Data collected on this form is used for funding, statistical and administrative purposes connected with your application. You have various rights to your data and further details and our full privacy notice can be found at www.coleggwent.ac.uk/privacy

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