YOUR DETAILS: please complete all sections of this form
FULL NAME:*
ADDRESS:*
TOWN:*
COUNTY or REGION:*
COUNTRY:*
POSTAL CODE:*
CONTACT TELEPHONE:*
EMAIL ADDRESS:

COURSE DETAILS:
COURSE TYPE* (please tick):	q Standard diploma £195.00	q Higher diploma £325.00	q Fellowship £525.00
COURSE TITLE:*
COURSE CODE:*		DYSLEXIA FRIENDLY?	q Yes please

DECLARATION: Please read carefully and then sign and date below
I have read and understood the terms and conditions of enrolment:
PRINT NAME:*
SIGN NAME:*
DATE: *
IMPORTANT: By signing this declaration, you are stating that you have read and understood our terms and conditions of enrolment. All enrolments are processed upon the basis that students have read, understood and accepted the terms and conditions of the college, and agree to comply fully with them.
Please now enclose your cheque made payable to "National Home Study" to the address shown above.
An asterisk * denotes a mandatory field that must be completed for your application to be accepted.