Our Next Open Event is on Thursday 1st February 5pm Р8pm

University Courses Application Form

1. University Course

Course applied for
 Early Years Foundation Degree Teaching & Learning Support Leadership & Management Foundation Degree BA Hons Working with Children in Early Years & Education

2. About You

Title

Surname

First Names

Previous Surname

Date of birth

Are you?
 Male Female

Have you lived in the UK or an EU Country for the past 3 years?
 Yes No

If 'No' then please state where

Home Address

Address

Postcode

Contact Details

Home Phone

Mobile

Email address

3. Your Qualifications

Please state all of your qualification details to date, starting with your most recent.

School/College/University

Subject Studied

Qualification/Level

Grade

Date achieved

4. Support For Your Course

The College is committed to meeting the needs of students with learning difficulties, disabilities and medical
conditions. To help us support you please complete the following

Do you have a

Disability:
 Yes No

Learning Difficulty:
 Yes No

Health Problem:
 Yes No

Please outline any relevant information below

5. Your Employment History

Position/Job Title/Duties

From

To

Employers Name and Address

6. Personal Statement in Support of Your Application

Please enter here any information you may wish to offer in support of your application. We are particularly
interested in your reasons for choosing the course, how you became aware of the course, your career aspirations,
and what attributes you possess that make you a suitable candidate.

7. Reference

Please provide the details of an academic referee, unrelated to you, who is prepared to recommend you for this
course. If you are unable to provide an academic referee please provide details of your employer.

Name

Position held

Organisation

Address

Postcode

8. Equal Opportunities

The college is committed to equality of opportunity to all ethnic groups within the community. To help us
achieve this please tick the relevant boxes.

Is English your first language?
 Yes No

How would you describe your ethnic background?

White
 31. English/Welsh/Scottish/N.Irish/British 32. Irish 33. Gypsy or Irish Traveller 34. Any other White Background

Black/African/Caribbean/Black British
 44. African 45. Caribbean 46. Black British/Black other

Mixed/Multiple ethnic group
 35. White and Black Caribbean 36. White and Black African 37. White and Asian 38. Any other mixed/multiple ethnic background

Other ethnic group
 47. Arab 98. Any other ethnic group

Asian/Asian British
 39. Indian 40. Pakistani 41. Bangladeshi 42. Chinese 43. Any other Asian Background

9. Tuition Fees

Please select the payment method for your course
 Employer/Sponsor Tuition Fee Loan Self - Funding

10. Criminal Conviction Declaration

HAVE YOU EVER BEEN CONVICTED OF A CRIMINAL OFFENCE?
 Yes No

(You do not need to disclose speeding tickets).
If you have answered Yes please give brief details and dates of any offences below

Please note this information will be kept confidential

11. Declaration

I declare that the information on this form is correct and accurate to the best of my knowledge.
I understand that any offer of a place is subject to my acceptance of the College's terms and conditions.
I agree that the College may record and process the information contained in this form for statistical and
administrative reasons in accordance with the Data Protection Act 1998.

Student Signature

Date

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