Course Title Course code
2nd Choice Course code
Alternative interest (if known)     

Title: Mr Mrs Miss Other (Please State)
Surname First Name

Address
Postcode
Date of Birth Age on 31st August 2010 Gender Male Female
Email Address Mobile Number
Home Telephone Work Telephone
Emergency contact
Emergency telephone number
National Insurance Number
Have you ever been convicted of a criminal offence, or are you currently undergoing criminal investigation? Yes No  
How did you hear about the course?
Returning Learner School Careers Service Friend Prospectus Newspaper
Website Radio Cinema Bus Poster
Other (Please state)
Please indicate your ethnic origin by selecting from the following choices
Asian or Asian British-Bangladeshi Asian or Asian British-Indian Asian or Asian British-Pakistani
Asian or Asian British-Other Asian Mixed-White & Asian Mixed-White & Black African
Mixed-White & Black Caribbean Mixed-Other race Black or Black British- Africian
Black or Black British-Caribbean Black or Black British-Other Chinese
White-British White-Irish White-Any other white
Any other Not Known/Not Provided  
Learning Needs
Will you need support for any particular learning requirements whilst you are on your course? Yes No
Blind/Visual Impairment Deaf/Hearing Impairment Speech Difficulties Wheelchair use
Other mobility needs Dyslexia Mental Health ADHD
Other (Please state)
Do you have a medical condition that significantly affects daily life? Yes No
Please specify
Do you need extra support with exams? Yes No
Please specify
If you are between 16 and 19, did you have a statement of special educational needs when you were at school? Yes No
Your Citizen status
What is your nationality?
Have you been living continuously in the UK or EU as a citizen since 1st Jan 2005? Yes No
If you have lived somewhere else please write the name of your country of ordinary residence?
Do you have permanent leave to remain in the UK/EU? Yes No If yes, when was that leave granted?
Are you an asylum seeker? Yes No Are you subject to visa restrictions? Yes No
Is English your first language? Yes No If No, please specify
Your Qualifications
Your current/last secondary school (under 19's only)
Other than school, have you attended an educational establishment in the past academic year? Yes No
Bexley College Higher Education Adult Education Further Education College Other
Please state the qualifications you have acheived in the past 5 years (or will be taking this summer)
Subject Level Date Grade   Subject Level Date Grade
 
 
 
 
 
 
For School Leavers applying for courses commencing September 2010 we will need details of your predicted grades and a reference regarding attendance and discipline (and additional learning support and/or special needs if necessary) covering the previous two years. Please ask your School/ Head of Year for help with this.
What was you highest national qualification prior to this enrolment?
               
Entry Level (Skills for Life) Other qualifications below Level 1 Level 1 (GCSE's E-G)
Level 2 (Five GCSE's A*-C, Foundation, NVQ) Level 3 (Min 4 AS/1xA2 + GCSE A*-C, BTEC National)
Level 4 (Foundation Degree, HND, Professional Qualifications) Level 5 (Degree)
Work Experience / Employment
Please give details of any work experience or employment that is relevant to your course.
Thank you for completing this Application Form. We will contact you in due course to arrange an interview with your Course Tutor (if necessary), and you may also be asked to take a short aptitude test. All the information on this form will be held subject to the terms of the Data Protection Statement for 2009/2010, 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.
You must fill in the following two boxes otherwise we can not process the form.
I declare all the information on this form is correct Date
IMPORTANT - Please check that you have filled out the information in this form correctly as, once you click the button below, the information will be sent directly to our Guidance & Admissions department for processing.