Surname:

Forename(s) in full:

Middle Name(s):

Tel No:

Mobile:

Home Address:

Mr/Mrs/Miss/Ms: Choose an option Mr Mrs Miss Ms

Date of birth:

Nationality:

Postcode:

Email:

Please provide next of kin details (must be parent or guardian) if you are under 18 years

Name:

Telephone:

Study Details

Course/Programme for which application is made:

Year of Entry:

Your Local Education Authority:

Education

Your present/last school

Please list all secondary schools attended up to the age of 16, with dates of entering and leaving

Qualifications

Please list all the qualifications you gained at school

Further Study

Please list all full-time and part-time courses which you have followed since the ago of 16

Learning Difficulty/Disabilities

a) Do you think that you have any learning difficulties or disabilities?

Please tick the relevant box below.

 No Learning Difficulty  No Disability  Temporary Disability  Profound Complex Disabilities  Aspergers Syndrome  Multiple Difficulties  Disability Other  Moderate Learning Difficulty  Severe Learning Difficulty  Dyslexia  Dyscalculia  Autism Spectrum Disorder  Multiple Learning Difficulties  Learning Difficulty Other  Visual Impairment  Hearing Impairment  Disability Affecting Mobility  Other Physical Disability  Other Medical Condition  Emotional/Behavioural Difficulties  Mental Ill Health

b) Are you registered disabled?

Practical Experience

Please give brief details of all full and part-time experience relevant to your preferred programme of study

Interests & Hobbies

Please include interests, hobbies, team memberships, sporting or other successes, club membership - and any information you may think important to support your application (continue on a separate sheet if necessary).

Career Ambitions

Please state your future career ambitions

Ethnicity

References

Please give the full name, address and occupation of two people willing to recommend you.

If you are still at school one of these must be your Head of year: Please note that referees must not be relatives.

Name:

Address:

Telephone:

Occupation:

Name:

Address:

Telephone:

Occupation:

Failure to provide this information may result in a delay in the application being processed.

Criminal Convictions

The College has a duty of care, particulary to learners who are under 18 years of age. In view of this all applicants are required to declare any criminal convictions. All information given will be treated as sensitive data under the Data Protection Act and dealt with in accordance with our Equal Opportunities Policy and Admissions Policy.

Do you have any unspent criminal convictions? (excluding fixed penalty driving offences)

If YES you will be asked for further details at interview

How did you find out about this College?

Declaration

I understand that the information forms the basis on which a place at the College may be offered to me, and declare these particulars are to the best of my knowledge correct. I also understand that the place may be withdrawn if undeclared criminal convictions come to light.