2017 - 2018 Student Application Form


Personal Details
Title   Other
Family Name    
Given Name(s)
Mobile   
Email
Date of Birth
Age on 1st September 2017
Gender (please check) MALE FEMALE

Living Arrangements
Do you live at the parental home? (please check)
YES NO
Address
Town
County
Post Code
Home Telephone
You must inform the college if your personal information changes

Emergency Contacts
Should an emergency occur at college, it may be necessary to contact someone urgently. Please supply some emergency contacts (e.g. parent's / relative's work telephone number).

Parent's / Guardian's Name (please check as appropriate)
Family Name
Relationship to Student
Address
Town
County
Postcode
Mobile
Home Telephone
Email

Second Emergency Contact (please check as appropriate)
Relationship to Student
Address
Town
County
Postcode
Mobile
Home Telephone
Email
Student ID
Ignore if not known

Unique Learner Number.
Ignore if not known

Name of Present or Last School / College with Leaving Date
School Name
Address
Date of Leaving (dd/mm/yyyy)

Learning Difficulty/Disability/Health Information (please check)
Do you consider yourself to have a learning difficulty or disability?
YES NO


Ethnicity (please check)

Eligibillity for Funding (Fee Remission)
Have you been a resident in the UK/EU for the past three years? (please check) i.e since August 2013 YES NO
If you have answered NO to the above questions we will discuss this with you in your advisory interview.
Date of Entry to UK (dd/mm/yyyy)
Is English your second language? (please tick) YES NO

Examinations Taken or to be Taken        
Examinations Subject(s)
Level e.g. GCSE, BTEC
Month/Year Taken, To Be Taken
Mock/Forecast Result
Actual Result Where Known
English Language
English Literature
Mathematics

Why do you want to come to college?

Careers which Interest You

Current Part-Time or Full-Time Work
Employer
Job Description
Dates
List below your Interests and Activities

Please list any relevant Work Experience


Please list the Examination Courses (subjects and levels) you are interested in taking at College (to be discussed at advisory interview)
Type of course
{e.g. AS/AGCE/Level 2 diploma/GCSE}
Subject{s}

Where did you hear about the College?

Data Protection Act

Information you provide on this application form will be stored and processed and, because of the Data protection Act 1998, we need your permission before we can do this. Since we cannot operate the College effectively without processing information about you, we need you to sign the statement below. Further information about data confidentiality is available on request from the College.


If you do not agree we cannot process your application.


Before clicking the button below, please check that you have included all your details and that they are correct, any errors may cause a delay in the application procedure.

* = Required fields

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