Distance Learning Enrolment Form - London School of Theology

Enrolment FormEnrolment FormA copy of this form will be sent to the tutor marking your work. Please answer all questionsas fully as possible, as this will help the marking process. If you think you might want to takemore Distance Learning Modules through LST, making a photocopy of this form once you havecompleted it will avoid you having to answer the same questions for each enrolment.For official use onlyEnrolment date:End Date:Marking:1. Please enrol me for the ModuleTitleReference Code2. SurnameTitle & First Name(s)3. AddressPostcodeCountry4. Contact NumbersWorkHomeMobile4B. Email (please print)5. Date of birth6. Present occupation7. To what Christian fellowship or denomination do you belong?8. It is often helpful for Distance Learning students to have eithera person or a small group with whom they can discuss theirstudies. Do you have such a person/group?9. It is often useful also to put Distance Learning students incontact with each other. Are you happy for us to pass yourname and address on to other students?YesNo10. What educational standard have you reached, formally?Please tick the box of your highest level.‘O’ level/GCSE‘A’ levelNVQFirst degree (Bachelor)Second degree (Master) Third degree (Doctorate)Other (name)11. Do you want this module to be supplied in electronicformat? if so, do you wantemail CD ROM12. Are you considering registration with Middlesex Universityfor a validated qualification?Yes, please send me all details and forms.I am already registered with MiddlesexNo, thank you.13. If you have studied previous London School of Theologydistance-learning modules, please indicate which, giving dateswhere possible.001/001A: Introducing the Old Testament002: Introducing the New Testament003: Introducing Christian Doctrine004: Introducing Christian Ethics005: Introducing Church History008: Going the Distance007: The Four Gospels006: Reading the Greek New Testament600: New Testament GreekAny other modules (please name)YesNocontinued overleaf…

Enrolment Form14. How did you hear about LST distance learning courses?15. If you have done any other formal theological study (with adifferent college, residential training etc.) please tell us what.16. If you are aware of anything that you would like your tutorto pay particular attention to, or feel he/she should know,please indicate this below (or use a separate sheet of paper).18. Payment: tick all boxes that applyI am paying only for this individual module.I wish to start a Special 120 program.I have already paid for a Special 120 program, and so makeno payment for this course.I am claiming a discount, for which I enclose evidence of mystatus.I include extra for airmail costs.19 Payment methodI enclose a cheque/postal order for £(payable to London School of Theology)Please charge the sum of £to my card account.I am aware that there is a 2% surcharge for credit cards (but notfor debit cards).Mastercard Visa MaestroCard NumberExpiry dateMaestro - Issue Numberor Start Date17. We offer four different price and marking alternatives forour courses. Please indicate which of the four you are applying for.A. ‘Academic’ marking, with the module to be completedwithin one calendar year (with the possibility of extensionon payment of a supplement). Students on an accreditedcourse must choose this option.B. ‘Academic’ marking, with a three-year study period forcompletion of work (you may apply for a refund if youcomplete the module within one calendar year).C. ‘Vocational’ marking, with the module to be completedwithin one calendar year (and the possibility of extensionon payment of a supplement).D. ‘Vocational’ marking, with a three-year study period forcompletion of work (you may apply for a refund if youcomplete the module within one calendar year).3 Digit security code20. The material we will be sending you is intended for yourprivate and personal use, the copyright belonging to LondonSchool of Theology. You may not make photocopies of theprinted copies nor may you print off from the electronic copyfor distribution to anyone else. You may make a single copyor printing for your own use only. Please sign to indicate youracknowledgement of this.SignedPlease send the completed form to:DateDepartment of Open Learning, London School of Theology,Green Lane, Northwood, Middlesex, HA6 2UW.If you have any enquiries contact us viatel: 01923 456230 or e-mail open@lst.ac.uk;www.lst.ac.ukIn accordance with the Data Protection Act, the School is required to inform you that information is held on computer for the purposes of maintaining records. Any enquiriesabout computerised records should be made to the Director of Open Learning. London School of Theology is a Registered Charity No. 312778. VAT Reg. 581 7532 24.