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Forename(s):

Surname:

Address:

Date of Birth: (DD/MM/YYYY)

Title:

DR MISS MR MRS MS

E-mail address:

Course type:

Access Studies Access Studies - Classroom Access Studies - Lab / Workshop Adult Basic Education / English for Speakers of other Languages Applied Science Business Admin Caring & Health Catering Communication Skills Computing Construction Engineering General Education GCE / GCSE - Classroom General Education GCE / GCSE - Lab / Workshop General Education GCE / GCSE - Studio Hairdressing & Beauty Independent Living Skills - Moderate Independent Living Skills - Profound Land Based Skills N/A Non Vocational Other General Education Perfoming Arts / Art and Design Secretarial and Office Technology Tourism and Leisure Welsh For Adults

Comments/Notes:

Brecon

Llandrindod Wells

Newtown

An Outreach Centre

Open / Distance Learning

Other (please specify)

Which site are you interested in studying at?

Preferred Name:

Coleg Powys Enquiry

Post Code:

Full-time (Futures)

Part-time (Directions)

Evening (Adult & Community Education)

Via employer (WBL)

Other (please specify)

How would you like to attend this course?

If you would like information about specific types of courses please supply the following information:

Full-time (Bilingual)

Part-time (Bilingual)

Evening (Cymraeg)

Evening (English)

If you would like a prospectus please tick any of the following:

Yes

No

Have you previously attended Coleg Powys?

Contact Telephone Number (inc. Code):

Previous Surname:

Mobile Telephone Number:

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