Application Form Please write in CAPITALS

Transcription

1 Application Form Please write in CAPITALS Course Details - Please include up to two programmes of study. For example: A Levels or Extended Diploma in Engineering Course Title If you are applying for AS/A2 or GCSE levels (delete as appropriate) please list the subjects here: Have you previously applied to or attended Kingston College? Yes No Personal Details Surname First Name Date of Birth / / Title Mr Miss Ms Mrs Sex M F National Insurance No. Address Home Address Address of Parent/Guardian Name and Address of Parent/Guardian Tel Home Mobile Tel Home Mobile Residency in the United kingdom Please provide your Nationality Which Passport do you hold? Please state which country you normally reside in Do you have or will you need a Tier 4 Student Visa to study in the UK? Yes No Applicants who normally live outside the European Area (EEA/EU) - may need a Tier 4 visa in order to study in the UK What residency status/permission do you have in order to live in the UK? Have you been a permanent resident in the UK for the last 3 years? Yes No If NO, please indicate which country/countries you have been living in for the last 3 years and your date of entry into the UK Country Date / /

2 How did you hear about Kingston College? Advertisements College Literature Connexions Family / Friends Website Previous Attendance Employer School Have you attended a Kingston College Open Event? Yes No Equal Opportunities - This information is for monitoring purposes only What do you consider your gender to be? Male Female Transgender What do you consider your ethnic origin to be? Asian or Asian British - Bangladeshi Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Any other Asian background Black or Black British - African Black or Black British - Caribbean Black or Black British - Any other Black British Chinese Mixed - White and Black African Mixed - White and Caribbean Mixed - White and any other mixed backgroud White - British White - Irish White - Any other white background Any other Not Known / Not provided Mixed - White and Asian What do you consider your sexual orientation to be? Bisexual Gay man Gay woman/lesbian Hetrosexual (attracted to the opposite gender) Other (please specify) What do you onsider your faith/religion to be? Buddhist Christian Hindu Jewish No religion Sikh Other (please specify) Muslim

3 School/College Details If you are still attending or have left school/college within the last 4 years, please give details of your most recent school/college. School/College Name School/College Address Form/Personal Tutor From To Qualifications achieved or to be taken Level eg GCSE, AS/A2 Level, HND Subject eg. Maths, Motor Vehicle Grade Achieved/Predicted Date Achieved/to be taken Please note - When you start a course at Kingston College you will be asked to show proof of examination results. Additional Information Please supply relevant information about yourself, include any previous experience in your chose area, including work experience, previous employment, membership of professional bodies, hobbies, interest etc. Continue on a separate sheet of paper if necessary. If you are applying for CIPD, Institute of Legal Executives or Management courses please also attach your CV

4 Criminal Conviction Disclosure Kingston College is an inclusive college and we are keen for all learners to be well cared for. We therefore ask all learners to declare if they have any criminal convictions. If you answer yes, you will be asked to provide further details. This does not automatically affect your admission, but allows the College to undertake a risk assesment and provide support as appropriate. Do you have any criminal convictions? Yes No Learner Support Kingston College is commited to meeting the requirements of all our learners and offers services to support learners with additional needs, learning differences and medical conditions. These may include: Physical disability or reduced mobility Hearing or visual impairment Learning differences such as dyslexia, dypsraxia, semantic pragmatic disorder Mental health difficulties ADHD Autistic spectrum disorders including Asperger s syndrome Emotional, social and behaviour differences Do you consider yourself to have a disability and/or medical condition? Yes No Visual impairment Hearing impairment Disability affecting mobility Other physical disability Other medical condition (for example epilepsy) Emotional/behavioural difficulties Mental ill health Temporary disability after illness or accident Profound complex disabilities Aspergers syndrome Multiple disabilities Other Do you consider yourself to have a learning difference/difficulty Yes No If yes, please tick which most describes your difference/difficulty? Dyslexia Dyscalculia Disability affecting mobility Autism Other specific learning difficulties (ADHD, speech or language disorders) Moderate learning difficulties Severe learning difficulties Multiple learning difficulties Other

5 Have you ever recieved Addtional Learning Support? Yes No If yes, please tick which best describes the support you received: support Exam concessions In-class support Out of class support If you have ticked one of the above, what evidence do you have to support your needs? Learning Disability Assesment Other Evidence No formal evidence Are you receiving support from Social Services? Yes No If yes, please tick which most describes your circumstances A care leaver A vulnerable adult A young carer A young person in care (including foster care) Out of class support Would you like to discuss these needs with a member of the College support team? Please indicate belosw and we weill contact you to arrange this. Yes No Reference Details Fill in your details on the Reference Form and pass to your Referee (Form/College Tutor/Employer). If you are over 20 we may accept a reference from your employer or someone who knows you well. Reference may not be completed by a relative. We cannot process an application form until a reference has been received. Declaration Check that all sections have been completed. Sign, date and return this form to Kingston College. Signature of Applicant Date / /