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The Leith School of Art25 North Junction StreetEdinburgh EH6 6HWTelephone: 0131 554 5761Web: www.LeithSchoolofArt.co.ukEmail: [email protected]
Application for Community ClassTitle:Forename(s):Surname:
Address:
Postcode:Telephone (Day):Telephone (Mobile):Email Address:
Supporting evidence of state benefit enclosed:(Please list all documents you are sending)
Please note we accept the following: Job Seekers’ Allowance, Income Support, Child Tax Credit, Working Tax Credit, Housing Benefit, Employment and Support Allowance, Disability Living Allowance and Attendance Allowance or Severe Disablement Allowance, or your sole source of income is a DWP State Retirement Pension and Pension Credit.
Will you be accompanied by a carer/support?What is their relation to you? (If they’re working for an organisation, please state its name)
Please tick which class you would like to join:
Monday Afternoon (2pm – 4:30pm) Tuesday Morning (10am - 12:30pm)
Tuesday Afternoon (2pm – 4:30pm)
EMERGENCY CONTACT:Name:
Relationship to student:
Address:
Telephone (Day):Telephone (mobile):
HOW DID YOU HEAR ABOUT OUR COMMUNITY CLASSES?
Word of mouth Flyer/Brochure Facebook Twitter
Instagram Advert LSA website
Other, please specify:(If you have been referred by an organisation, please state its name)
Signed:
Date:
Please complete and send to: Short Courses Administrator, Leith School of Art, 25 North Junction Street, Edinburgh, EH6 6HW. Email: [email protected]
The Leith School of Art is a Company Limited by Guarantee and having Charitable Status. Registered in Scotland at 25 North Junction Street, Edinburgh. Registered No.111089. Scottish Charity Number SCO07456ED327/88.
