PLEASE COMPLETE ALL FIELDS

1. Personal details

Title

Full Name

Gender

MaleFemale

Age on Sept 1 2018

Date of Birth (DD/MM/YYYY)

Nationality

NI Number (Please enter NA if you do not have your National Insurance number)

Home Address

Post Code

Tel No.

Mobile No.

Email

Emergency Contact Details:

Full Name

Tel No.

Mobile No.

Email

Relationship to You

2. Your course

Please let us know your choice of course below. Codes can be found in the full-time courses guide next to the course title.

1st Course choice

1st Course Code

2nd Course choice

2nd Course Code

3. Examinations

Already taken and / or to be taken in the current academic year. Please list in order taken.

NB: Failure to disclose this information may affect your application. You will be required to provide original certificates when you enrol.

4. Relevant practical experience and employment

Please give any details of work experience relevant to your choice of course. Please continue on a separate sheet if necessary.

5. Career ambitions

6. Hobbies and Interests

7. Present , or most recent school, college or education provider

8. Accommodation

Are you planning to apply for accommodation on campus?

YesNo

9. How did you hear about Kingston Maurward College?

10. Additional learning needs / disabilities

Do you have a disability and / or medical condition?

YesNo

If ‘yes’ please indicate:

Visual impairment (01) (excluding glasses)Hearing impairment (02)Disability affecting mobility (03)Other physical disability (04)Other medical condition* (05) (e.g. epilepsy, asthma)Emotional / behavioural difficulties (06)Mental ill health (07)Temporary disability after illness (08) (e.g. post viral)Profound, complex disabilities* (09)Aspergers syndrome (10)Multiple disabilities (90)Other (97)

If “Other” provide further details

Please list any support needs that you have in order to be able to attend an interview (e.g. wheelchair user).

Do you have a learning difficulty?

YesNo

If ‘yes’ please indicate:

Moderate learning difficulty (01)Severe learning difficulty (02)Dyslexia (10)Dyscalculia (11)Other specific learning disability (19)Autism Spectrum Disorder (20)Multiple learning difficulties (90)Other (97)

If you need advice or guidance regarding disability or learning difficulty, please contact us for additional learning support. We collect this information to enable us to give you relevant support while you are at college.

11. Criminal convictions

Do you have any unspent criminal convictions?

YesNo

If yes, please provide details:

12. References

Please give the name and full postal address of your referee. Your referee must be from your last school, college or employer.

Type

AcademicEmployment

Full Name

Home Address

Post Code

Relationship to You

13. I apply for admission to Kingston Maurward College

Student Name

Date (DD/MM/YYYY)

For applicants under the age of 18:

I (as a parent, guardian or major) undertake to pay all the relevant fees and other charges due to Kingston Maurward College, in accordance with the rules, in respect of the above applicant. I understand that residential fees are payable termly in advance and non-refundable as published.

Parent Name

Date (DD/MM/YYYY)

I understand that failure to disclose any of the above information may affect my place at Kingston Maurward College.
I understand

14. Data protection

I understand that the information I provide for my application will be retained by Kingston Maurward College in order to process my application and generate a place for me at College. This information will be held securely by the College in accordance with the requirements of the Education and Skills Funding Agency and the College’s Data Protection Policy. It will not be made available to any third party organisations except those who have a direct involvement with the facilitation of college courses. If I choose not to study with Kingston Maurward College the information on my application form will be destroyed.
I understand