University Application Form

Course Location *

Course *

Course Option *

Course Code

Tell us why you want to study this course *

I have already studied towards a higher Level (level 4, 5 or 6) qualification

Yes

A member of our team will be in touch with you to discuss this further with you.

Title *

First Name *

Surname *

Gender *

Where are you from? (nationality)

Date of birth *

Contact Tel Number *

Required Format: 01234 567890

Email *

Email Confirm *

National Insurance No.

Have you been a UK resident for at least 3 years *

Yes

Please tick which group best describes your ethnic origin *

31 White English / Welsh / Scottish / Northern Irish / British

32 Irish

33 Gypsy or Irish Traveller

34 Any Other White Background

35 White and Black Caribbean

36 White and Black African

37 White and Asian

38 Any Other Mixed / Multiple Ethnic Background

39 Indian

40 Pakistani

41 Bangladeshi

42 Chinese

43 Any Other Asian Background

44 African

45 Caribbean

46 Any Other Black / African / Caribbean Background

47 Arab

98 Any Other Ethnic Group

Do you have a disability? *

Yes

Disabilities

Learning Difficulties

Futher Details

Would you benefit from specialist support on your course due to one of these conditions?

Yes

Home address

Address

Type a postcode to autocomplete

Address 1 *

Address 2

City *

Postcode *

County *

Education

Previous Education Establishments

Do you already know your qualifications?

Yes

Known Education Qualifications

Unknown Education Qualifications

How did you hear about us?

Local Newspaper (e.g. Sentinel)

Part-time prospectus

Search Engine (e.g. Google)

Word of Mouth

Signal Radio

Facebook

Twitter

Yell.com or Yellow Pages

Other

Do you have any criminal convictions? (excluding fixed penalty driving offences) If yes, this will be discussed at your interview *

Yes

The information you provide will be passed to the SFA (Skills Funding Agency). The SFA is responsible for funding and planning education and training for young people and adults in England and is registered under the Data Protection Act 1998.For further details please visit http://skillsfundinga gency.bis.gov.uk I consent to you processing the information which I have supplied. I am also happy to receive information about courses and other college news and provide information for research purposes.

All the information I have supplied on this form is true and accurate at the time of completion.

Yes