APPLICATION FORM PERSONAL DETAILS
for entry in September 2014 Equal Opportunities Monitoring
(please complete in block capitals)
The college is committed to Equality of Opportunity and welcomes applications from all learners irrespective of gender, sexuality, disability, race, belief or background (you can view our Single Equality Scheme on our website). We are legally required to obtain data on the ethnic origin of our students – please tick one box which you feel best describes you.
Surname First Name Address
Dual Heritage White and Asian
Postcode Have you lived at this address for more than 3 years?
White and Black
Black or Black British African Caribbean
If not, please note previous address
Asian or Asian British Pakistani Bangladeshi Gender
Male
Female
Other Black
Indian
Other Asian
Date of Birth
White Irish
Email Telephone (Home)
British
Other White
Other (please specify, for example, Chinese)
Telephone (Mobile) Country of Birth Resident in the UK for the last three years or more at 1st September 2014? (must be completed) Yes No
Please tick if you speak English as a second language
If you are not currently at school, what was your previous school and what are you doing now?
CURRENT SCHOOL/COLLEGE
Previous School I am currently...
CAREER IDEAS Please provide one reference from your previous centre/programme: Surname
Please indicate your current intentions after College: Higher Education (e.g. university) Gap Year
First Name
Employment
Career Ambition (e.g. teacher, engineer, architect, lawyer)
Address
Postcode Please attach any reference statements provided in support of your application to this form.
QUALIFICATIONS
(list all you are entered for this year and any you have already obtained)
Qualifications In addition to listing your GCSE English Language and Maths grades
Subject English Language, Maths, Science etc
1
GCSE
English Language
2
GCSE
Mathematics
3 4 5 6
Grades gained to date
Predicted Grade for 2014 If available