NATIONAL  WOMEN'S  COUNCIL

Adult  Literacy  Enrolment Form

* are mandatory fields and need to be filled

1. Personal Details

Surname *
Other Name(s) *
Address *
Contact No * Any alternate Contact Number (if any)
Birthdate
Age
NIC No *
Gender Male      Female
Email address

2. Contact Person

Name
Phone
Relationship

3. Programmes offered (Tick as appropriate) *

 Basic Literacy Level 1
Basic Literacy Level 2
Kreol Morisien
Adult Literacy for Entrepreneurship Development (ALED) for Women

4. Level of Education (Select as appropriate) *

 Primary Education up to standard 3
Primary Education from standard 3 to CPE
Secondary Education, from Form 1 to Form 3
Secondary Education, from Form 3 to Form 5
Note that for Basic Literacy only those who had no schooling or studied only at the Primary Level may apply.

5. Previously enrolled in this programme (Tick as appropriate)

 Basic Literacy Level 1
Basic Literacy Level 2
Kreol Morisien
Adult Literacy for Entrepreneurship Development (ALED) for Women
If, yes, please indicate the year enrolled:

6. Availability (Tick as per convenience) *

 
Monday
Tuesday
Wednesday
Thursday
Friday
Morning
Afternoon

7. Goals (Tick as appropriate)

 Enter employment
Get a better job
Be more productive at work
Increase involvement in child's education
Read to children
Correct child's home work
Be a better parent
Be a more knowledgeable wife
Register to vote
Read mail
Write cheques
Pay bills
Read medical Prescriptions
Others:

8. Proposal for new Courses

Please indicate any new courses you would like to follow
1.
2.
3.

Should you need help to fill in the above form, please feel free to call Mrs Teeluck on 2173733 on Mondays and Tuesdays from 9.30 to 15.30 hrs and Mr Menelas on Wednesdays to Fridays from 9.30 to 14.30 hrs.

Date :