Part Time Course Application Form 2010/2011

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02. Personal Details

03. For monitoring Equal Opportunities, please describe your Ethnic Origin:      Please Select.. 11 Asian or Asian British-Bangladesh 12 Asian or Asian British-Indian 13 Asian or Asian British-Pakistani 14 Any other Asian Background 15 Black or Black British-African 16 Black or Black British-Caribbean 17 Any other Black Background 18 Chinese 19 Mixed White Asian 20 Mixed White Black African 21 Mixed White Black Caribbean 22 Any other mixed background 23 White British 24 White Irish 25 Any other White Background 98 Other 99 Not known/Not provided

04. Education
Name of school or college either currently attending or recently attended:

Examination(s) / Awards(s) Please list all the examination subjects/qualifications already achieved or to be taken
If you have no formal qualifications, please tick here

05. Details of paid employment to date

06.Referee

Please supply the name and address of a suitable referee (usually a former teacher or a professional person.)
References provided by relatives are not acceptable:

07. Support Requirements
This College is committed to ensuring that everyone is treated fairly. All reasonable adjustments will be made to ensure that any student with support needs is not disadvantaged. If you declare a support need we try to ensure that a specialist member of staff attends your interview to discuss your needs in full.
Do you consider yourself to be disabled?   Yes    No     Do you have a learning a disability or learning difficulty?   Yes    No 

Your disability / difficulty / support need:

Please give brief details of how we may help you. Please tell us if you need any special arrangements to be made for your interview, course or exams and how it would be best to communicate with you (letter, e-mail, mobile phone etc.)

08. How did you find out about the college?      

09. Availability to attend College for an inteview
The majority of our interviews are arranged during the daytime between Monday to Friday. Do you have any future comitments that would prevent you from attending an interview, for example work, holidays, exams etc? If so could you please specify any dates or times when you are unable to attend. (Interviews during school hours are normally acceptable providing the Head Teacher is given prior notice). Your parents/guardian (or partner) are very welcome to attend your interview with you.

I am unavailable for an interview on the following days/dates:

10. Additional Information
Do you have a criminal conviction which may effect your admission to College? You should not include any motoring offences. If you tick the ‘yes’ box, the College may ask for further details during your interview. If you do not tick either box, your form will be returned for completion.   Yes    No 

11. Delcaration:
I confirm that the information given on this form is true, complete and accurate and no information requested or other significant information has been omitted.

Applicants under the age of 18	Have you discussed your application with your parents or guardian?   Yes    No
	Are you in care at present?   Yes    No      Do you live independently?   Yes    No

Data Protection Act 1998 – The information you provide will be passed to the Learning and Skills Council (LSC), MIAP, The Information Authority and Data Services. The LSC is responsible for funding, planning and encouraging education and training for young people and adults in England, and is registered under the Data Protection Act 1998. The information you provide will be shared with other organisations for the purpose of administration, careers and other guidance, statistical and research purposes. Other organisations with which we share information include, the Department for Children, School and Families, the Department for Innovation, Universities and Skills, Connexions, Higher Education Statistics Agency, Higher Education Funding Council for England, educational institutions and organisations performing research and statistical work on behalf of the LSC or its partners. The LSC also administers the Learner Registration Service (LRS) which will use your information create and maintain a unique learner number (ULN). The LSC is also a co-financing organisation and uses European Social Funds from the European Union to directly or indirectly part-finance learning activities, helping develop employment by promoting employability, business spirit and equal opportunities, and investing in human resources. Further information about partner organisations and the ULN and what they do, may be found at www.lsc.gov.uk/providers/Data/help/ and by following the links to data protection.

At no time will your personal information be passed to organisations for marketing or sales purposes. From time to time students are approached to take part in surveys by mail and phone, which are aimed at enabling the LSC and its partners to monitor performance, improve quality and plan future provision.