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):

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?

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