Derwentside College - Online Course Enquiry Form

Front Street
Consett
Co. Durham
DH8 5EE
Tel: (01207) 585900
Fax: (01207) 585991

Email: enquiries@derwentside.ac.uk

Online Course Enquiry Form

Surname: *

Forename(s): *

Title: *

E-mail Address: * If you have no e-mail address, please enter 'None'

The type of course you are interested in:	Full-Time Part-Time

The course(s) you interested in:

Would you like further course information posted to you:	Yes please No thanks

Full Address: *

Postcode: *

Date of Birth: * Please use the format dd/mm/yyyy

Would you like a member of our Course Enquiry Team to contact you by telephone:	Yes please No thanks

Telephone Number (Home):

Telephone Number (Work):

What time would you prefer to be contacted:

Do you have any questions?

All fields marked with an asterisk (*) must be completed

Declaration: The above information will be held on computer in accordance with our registration under the terms of the Data Protection Act 1998.