Learner Form

Have you completed this form before?
--YesNo

First Name (required):

Surname (required):

Email Address (required):

Name of course (required):
---

Date of course:

Home address (required):

Postcode (required):

Are you Under 25 Years Old? (required):
YesNo

Telephone Number:

Union project that supported learning:

Has / Will this course:

a) Raise the level of your previous qualification (required):
--YESNO

b) Progress you within your career (required):
--YESNO

Job title:

Employment status:
--EmployedSelf employedRetiredStudentNot currently working

Which industry sector most closely describes your current role:
--FreelanceStaff JournalistCommunicationsMarketingPRStudentOther Public sector workerTrade Union staffOther

Are you a Union member?
--YesNo

Which Union do you belong to?

What is your membership number (if known)?

How do you define your gender?
--MaleFemaleOtherPrefer not to say

DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY?
--YESNO

Do you have any access requirements to help you take part in this training?
--YESNO

Are you willing to provide a case study for use in reports to Welsh Government?
--YESNO

What do you hope to get out of this course?

Do you have any requests or suggestions for further training you would like NUJ Training Wales to run?

Terms & Conditions By ticking this box I acknowledge I have read the policy and agree.

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