UK online Centres - About: Register Online


UK Online Student Registration Form It is important that you complete all sections of this registration form. All information provided by you to the centre is treated as confidential. Please note: this form requires a password to complete, and as such; can only be used from within one of the Gosport UK online Centres. Fields marked with an asterisk * are required.
Password:*	*
Title:
First Name:*	*
Surname:*	*
Address 1:*	*
Address 2:
Postcode:*	*
Telephone:
Email:
Please indicate your age range:
Equal Opportunities:
Are you currently:	Employed	Self Employed
	Full-time Worker	Unemployed
	Jobseeking	Home Duties
	Part-time Worker	Lone Parent
	Retired	In receipt of means tested benefit
	(Please tick any that apply)
Disabilities:	YES/NO
Do you have a disability?
Are you registered disabled?
Do you have a hearing impairment?
Do you have a visual impairment?
Do you have any problems with mobility?
If you have a disability and wish to make a centre aware of this condition, please speak to a member of staff. All information will be treated as confidential.
Service Delivery:
1. I found out about Gosport UK online Centres from the leaflet:
2: I found out about Gosport UK online Centres from:	Other(please state)

Gosport UK online Centres, Forton Centre, Mill Lane, Gosport, Hampshire, PO12 4QA Email: info@gosport.org Tel: +44 (0) 23 9258 8311 Fax: +44 (0) 23 9251 1186 Copyright © St Vincent College 2002

UK Online Student Registration Form