PLEASE COMPLETE ALL FIELDS

1. Personal details

Title

Full Name

Gender

MaleFemale

Age on Sept 1 2019

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

Current School

Home Schooled?

2. Your course

Please let us know your choice of course below.

Course choice

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. Accommodation

Are you planning to apply for accommodation on campus?

YesNo

7. Additional learning needs / disabilities

Do you have a disability?

YesNo

Do you have a learning difficulty?

YesNo

If ‘yes’ please indicate:

Visual impairmentHearing impairmentDisability affecting mobilityProfound complex disabilityMental health disabilityAsperger SyndromeTemporary disability after illnessOther physical disabilityOther medical conditionSocial and emotional difficultiesModerate learning difficultiesSevere learning difficultiesDyslexiaDyscalculiaAutism spectrum disorderOther specific learning difficultyOther learning difficultyPrefer not to sayOther

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 an Education Health Care Plan (EHCP)?

YesNo

Do you currently have Exam Access Arrangements EAA (ie. extra time, scribe etc)?

YesNo

7. Criminal convictions

Do you have any unspent criminal convictions?

YesNo

If yes, please provide details:

8. 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:

Parent/Guardian/Carer signature (if student is under 18)

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