UCL SCHOOL OF SLAVONIC
AND EAST EUROPEAN STUDIES
1. Personal Details: Title
Evening Course Programme 2014/2015
ENROLMENT FORM
First Name
Family Name
OFFICE USE ONLY R___
Mr/Ms/ Other:
SN____ NA___ PP___
Postal Address (Term-Time)
Daytime Telephone
E-mail Address
[Please note that e-mail is our primary
means of communication]
Evening Telephone
Occupation
Postcode:
How did you find out about this course?
2. Please give us details of the course(s) you wish to study.
For courses running on multiple days, please input the correct Course Code so we can allocate your preferred day.
Autumn Term
Winter Term
Summer Term
Course Code Language
Level
6/10/14 – 11/12/14
12/1/15 – 19/3/15
27/4/15 – 2/7/15
3. FOR INTERMEDIATE OR ADVANCED COURSES ONLY - Have you studied this language at SSEES recently?
If NO
If YES
Please tick this box to confirm that you have enclosed a completed assessment form with this application.
You do not need to complete an assessment form. However, please tell us the following:
Most Recent Course Level
Date of Last Lesson at SSEES
Name of Most Recent Language Tutor
(MM/YY)
4. FEE LEVEL (Please tick as appropriate)
Category
External
UCL Alumni & Staff Relatives
UCL Staff & Academic Visitors
UCL Students
University of London Staff & Alumni
University of London Students
10 Lessons (1 Term)
£280
£280
£280
N/A
£280
£280
20 Lessons (2 Terms)
£530
£385
£365
£260
£425
£385
30 Lessons (3 Terms)
£780
£560
£530
£390
£635
£560
Proof of Eligibility
Required?
NO
YES
YES
YES
YES
YES
5. METHOD OF PAYMENT (Please tick as appropriate)
Secure online payment (The payment website address will be provided by email once your place has been reserved)
Credit/Debit Card (Not American Express) - paid EITHER in person in the Evening Courses Office OR over the phone.
Cheque (Crossed, signed, dated and made payable to “UCL”)
Employer/Organisation to be invoiced for course fees. (A signed sponsorship document must be submitted.)
Name of Employer/Organisation:
Telephone:
Contact Name:
E-mail
If you are applying for a concessionary rate, please tick here to confirm you have enclosed proof of your entitlement
6. TERMS AND CONDITIONS
(i) Course fees must be paid in full in advance. (ii) If a student informs SSEES, in writing, of their decision to withdraw two or more weeks before the start of term, their course fees will
be refunded in accordance with our published cancellation policy. (iii) If a student informs SSEES, in writing, of their decision to withdraw less than two weeks before the start of term,
their course fees will not be refunded. (iv) No partial refund will be given for classes not attended. (v) If a class is postponed for any reason (including, but not limited to Bank Holidays,
teacher illness, personal circumstances and transport issues), the teacher will consult with students to establish a rescheduled date that is most appropriate for the majority of the
class. If a student is unable to attend the rescheduled class, a partial refund will not be offered. (vi) Once a student has enrolled it not possible for them to defer. (vii) SSEES cannot
accept responsibility for any unforeseen circumstances that may prevent a student from attending a course. (viii) SSEES reserves the right to cancel a course if the number of
enrolments fails to reach the minimum number required to run a class. In the event of course cancellation, all course fees paid in advance will be refunded in full. (ix) SSEES reserves
the right to replace a course tutor if unavoidable. (x) Students must be over 18 years of age.
I accept the above terms and conditions. I am over 18 years of age.
Date
Signature
Please post or e-mail this form to the SSEES Evening Courses Office before the closing date of the relevant enrolment period.
POST: Evening Courses Office, School of Slavonic and East European Studies, UCL, Gower Street, London WC1E 6BT.
E-MAIL: eveningcourses@ssees.ucl.ac.uk
TEL. +44 (0) 20 7679 8738