Learning Works :: Learning Choice Form

Open University
Learning Choice Form 2006-2007

Please print out this form, complete in BLOCK CAPITALS, sign and return to:
Learning Works, Human Resources, University of Glasgow, Gilbert Scott Building, Glasgow G12 8QQ
before 31st May 2007

Title of proposed course or learning activity :
at (name of college/learning provider)	Open University
Address
Tel No.
Cost of lessons :
Dates of lessons :

I cerify that I wish my learning allowance to be used for the above learning activity, and that I would like Learning Works to raise a cheque payable to the Open University, or make payment to the Open University on my behalf for the above course, which I will undertake

this application needs to be approved by Learning Works before the learning activity is undertaken
an official receipt must be retained, and sent to Learning Works prior to 30 June 2007

Your Name: (Block Capitals)
Staff No.:
Department:
Signature:		Date:

This form must be signed before your learning activity can be agreed.

For office use:

Learner ID:

Date received: