Bexley College

Inspiration for the future

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General

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Course Information

* Course Title

* 2^nd Choice Course

* Mode of Study

Bexley College Application Form
Please complete the form in full to apply for admission to Bexley College.

All required fields as indicated (*).

Personal Information

* Title

* First name

* Last name

* Home Address

* Postcode

* Date of Birth

* Gender

* Home Telephone

National Insurance Number

* Mobile Number

* Email Address

Residency

* Have you been permanently resident in the UK or EU for the past 3 years?

* Is there any restriction on the time you may stay in the UK?

* What is your first language?

* Do you need extra support for English as a second language?

* Please state Nationality

Support at Bexley College

By giving the College information about your disablilities or health needs, you will not be affecting your chances of getting on the course in any way. The information you provide will be shared with your teaching staff to make sure you get the support you need. For further information see our Disability statement.

Please tell us if you have any of the following?

Blind/Visual Impairment
Deaf/Hearing Impairment
Speech Difficulties
Wheelchair user
Other mobility needs
Dyslexia
Mental Health
Autism
Aspergers
Dyscalculia

Other (please specify) (e.g. epilepsy, diabetes, asthma)

Please give details of any further assistance or equipment you would require whilst at the College or for your assessment/interview stage (e.g. large print or sign interpreter)

Did you have a statement of special educational need while you were at school?

If yes, when was this dated?

Choice of Course

* Briefly, tell us your reasons for choosing this course:

Qualifications on Entry

Please list below all the qualifications you have or will be taking. Make sure that you fill in expected grades where applicable as these details will help us to place you on the most suitable course.

Subject	Type of exam	Date of exam	Predicted Grade	Achieved Grade

Hint: Use the add button to add more rows.

Reference Details

Please give us details of your School, College or most recent employer

* School/College/Most recent Employer name

* School/College/Most recent Employer address

* Dates you attended School/Employment:(mm/yyyy) From To

Ethnic Origin

* In order to help us monitor equal opportunities.
Please indicate your ethnic origin by selecting from the following choices.

Declaration/Consent to Process

Data collected on this form may be computerised. It is used both for statistical purposes within the College and it's Funding bodies and for sharing analysis with Schools, Colleges, Funding bodies and Local Authorities. I confirm that the information provided on this form is correct to the best of my knowledge and consent to this data being used above: *

If the Applicant is under 18

I agree with this application to the College and ensure compliance with the College Regulations.

Parent/Guardian Name:

Parent/Guardian Email:

Parent/Guardian approval:

Submit my Application

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All the information on this form will be held subject to the terms of the Data Protection Statement for 2011/2012 and will only be passed to Government Departments and Agencies for statistical record purposes. All data is held in accordance with the Data Protection Act. By sending Bexley college this form you agree all the data supplied is correct.

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