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Form: On-line Applications

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Which course(s)/programme(s) are you applying for?: *

Please state course code(s) where known (For A-Levels list all subjects)

Preferred mode of study: Full Time, Part Time, Apprenticeship:

Full Time

Part Time

Apprenticeship

When do you intend to start to your course?: *

Surname/Family Name/Last Name (if any): *

First Name: *

Middle Name (if any):

Previous Surname/Family Name/Last Name (if any):

Mr/Mrs/Miss/Ms:

Mrs

Miss

Male/Female:

Male

Female

Date of Birth: *

Age (Years/Months):

Nationality: *

Date of Entry to UK:

Address: *

Tel: Day (inc. area code):

Tel: Mobile:

Email Address: *

Have you changed your address in the last 3 years?:

Yes

If yes, please state previous address:

Parent/Guardian/Next of Kin Name:

Relationship to you (eg. Mother):

Address:

Tel: Day (inc. area code):

Tel: Mobile:

Last/Current School/College:

Name of School, College and Town. For reference purposes. Under 19's Only

Use this space to tell us about yourself:

Include why you want to do the course, your work experiences, interests, etc...

Employer Contact Name (if known) - For Apprentices only:

Company Name:

Address/Postcode:

Tel No: (inc. area code):

Tel: Mobile:

Please note, we can provide a recruitment service to support in your search for employment

Qualifications: *

Please state 'Course/Subject', 'Level/Qualification', 'Grade or Predicted' (where known), 'Year of Examination'. Please bring any certificates or evidence with you to interview

Additional Support Required:

Yes

Do you consider yourself to have a disability?:

Yes

The College encourages all individuals to develop to their potential. To help you succeed on your course we need to identify any additional support needs at this stage. We can offer assistance for learners who have a visual or hearing impairment, restricted mobility, a long term health problem, dyslexia or other learning difficulties. Please let us know if you have a statement of learning difficulties or disabilities. Please state below if you have any special requirements for your interview (e.g. wheelchair, interpreter, communicator) and/or if you feel that any other learning support will be required to assist you in your study.

How did you find out about the course(s)?:

Do you have any unspent criminal convictions or any charges pending?: *

Yes

You do not need to include any that are 'spent' under the Rehabilitation of Offenders Act 1974. If you ticked the yes option, you can be sure that we will discuss your situation in a sensitive and confidential way. I confirm that to the best of my knowledge the information given in this form is correct and complete.

Signature: *

Date: *

Data Protection Act 1998: We will need to hold and process the information which you give, this will not be disclosed to other parties or organisations.

Eligibility: Have you been ordinarily resident in the UK for the last 3 years?: *

Yes

If you answered 'No' to this question, we will need to see your passport and Home Office immigration documents. You may be asked to provide evidence of residency. In order to qualify for College Bursary payments you must meet residency criteria. If you feel that you do not meet residency criteria, please tick the following box and an appointment will be made for you with a College representative.

Do you meet residency criteria: *

Yes

NOTE: Press the submit button below once only, after which there may be a short delay while your details are being processed. Thank you!

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