Untitled Document

Personal Details

Title
Forename(s)
Surname
Address

Town
County
Postcode
Telephone (home)
Telephone (mobile)
Email address
Date of birth
Do you have a relevant (unspent) criminal conviction? (If yes or unsure you will be required to provide details on form CSV8, available from the enrolment centre) Yes No

Nationality
Ethnicity
Have you been permanently resident in the UK and/or the European Union in the last 3 years? Yes No
Do you have a student visa? Yes No
Guardian Details
Name
Address

Town
County
Postcode
Telephone

College Course/Programme

Chosen course:
Secondary Choice:

For GCSE/AS levels please list choices if known:

Choice 1:

Choice 2:

Choice 3:

Choice 4:

Choice 5:

Choice 6:

What are your future career plans?

If you are undecided and would like a guidance interview, please tick this box and we will contact you

How did you first find out about these college courses?

If other, please specify:

Please tell us about your hobbies & interests

Health

Do you have a health condition (including epilepsy, asthma, mental health, arthritus etc)?

Yes No

If yes, please give details:

Additional Learning Support

The college can provide many different types of support. If you need any extra help with your studies we can offer group support, one to one, in class, mobility and focus workshops. Please tick all relevant boxes.

English	Exam Support / Concessions	Autism / Aspergers syndrome
Maths	Specialist individual support	English as a second language (ESOL)
Dyslexia/Dyscalculia	Blind / Visual impairment	Access to rooms & buildings
Deaf / Hearing impairment	A specific learning disability	Other

Education

Please give details of all secondary schools and colleges attended

School / College	From	To

Employment

Please give details of your most recent employment, including saturday jobs and work experience.

Job Title:

Start Date:

Company Name:

Finish Date:

Duties, responsibilities,
achievements, comments:

Examinations

Please list all examinations to be taken before starting college.

Exam (e.g. GCSE/NVQ)	Subject	Forecast Grade

Please list any qualifications already obtained.

Exam (e.g. GCSE/NVQ)	Subject	Date Taken	Grade

Learner Declaration
I give my consent to the College to pass on any information I have disclosed regarding any learning difficulty/disability or health condition, to the relevant member(s) of College staff to help me with my studies. I understand that in accordance with College policy I must disclose any relevant criminal conviction(s) by completeing form CSV8 (available from the Enrolment Centre) I understand that my application may be subject to an Assessment of Risk by the College if I have disclosed a criminal conviction or health condition. I agree to the College processing personal data contained in this form and other data which the College obtains from me or other people whilst I am a student. I agree to the processing of such data for the purposes connected with my studies or my health and safety whilst at college. From time to time the College may text information on College courses and services. Please tick this box if you do not wish to receive such information
I agree to the above statements.	Date : 31/07/2010
Click here to: