Westminster Kingsway College Application for 2018 /19

Surname/Family Name Westminster Kingsway College Application for 2018 /19 This College forms part of the Capital City College Group If you require a copy in an alternative format please email the Course Information Team: courseinfo@capitalccg.ac.uk or call 020 7700 9200 Did you know you can submit your application online? Visit http://www.westking.ac.uk/apply/ Office Use Only Reference Number Interview Support International Please complete in BLOCK CAPITALS using BLACK or BLUE INK and keep a copy for yourself. Return completed application and reference form(s) to: Registry (WKC), Centre for Business Arts and Technology, 444 Camden Road, London, N7 0SP Section 1 Your personal details Please enter your name as it appears on official documents: Office Use Only AG Family Name/Surname Title: Mr Mrs Miss Ms Other First Name(s): Male Female Date of Birth (DD/MM/YYYY) Age on 31 August 2018 Unique Learner Number - ULN (if known) Current Home Address Country: Postcode Tel (Mobile) Email Address Tel (Home) Section 2 Course(s) you would like to apply for (up to two full-time courses only) You can apply for two full-time courses of study, for example 3 or 4 A Levels = 1 full-time course of study. If you are choosing A Levels you need to select a minimum of 3 subjects and a maximum of 4 subjects. Course Name Level Course Code (Please list in order of preference) (as on website or Choice (Please tick to indicate your choice prospectus) for each course you have chosen) e.g. BTEC Level 2 Diploma in Sport Science 2 AS2217MT 1 2 Applicants aged 16-18: the reference form at the back of the application must be completed by your school or college and submitted to us before your application can be considered. First Name(s) Reference Number 1

Section 3 Additional support The College welcomes applications from learners of all abilities and we are committed to supporting applicants through the admissions process. To ensure that we provide you with the best support available, please indicate any learning difficulties, disabilities or support requirements that you will need at your interview. SUP Learning Difficulties 10. Moderate learning difficulty 11. Severe learning difficulty 12. Dyslexia 13. Dyscalculia 94. Other specific learning difficulty (e.g. Dyspraxia) 14. Autism spectrum disorder 00. No learning difficulty 98. I do not wish to give this information 96. Other Please specify Disabilities / Medical Conditions 04. Visual impairment 05. Hearing impairment 06. Disability affecting mobility 93. Other physical disability 95. Other medical condition (e.g. epilepsy, asthma, diabetes) please specify 07. Profound /complex disabilities 15. Asperger syndrome 01. Serious visual impairment 02. Hearing aid user 00. Wheelchair user 09. Mental health difficulty 97. Other please specify 08. Social and emotional difficulties 17. Speech, language and communication needs 16. Temporary disability after illness (e.g. post-viral) or accident please describe 98. I do not wish to give this information 03. No disability Are you living in the care of social services, leaving care services or living in any type of hostel accommodation? Yes No Applicants aged 14-16: Have you been adopted from care and/or on a Special Guardianship or Residence Order? Yes No Applicants aged 14-19: did you receive Free School Meals in 2017-18 (September 2017 to June 2018)? Yes No Will you need additional support at interview for your disability/learning difficulty, for example a communication support worker if you are deaf? Yes No If yes, please specify what you will need below Please let us know if you think you may need help while you are at the College. ESOL (English for Speakers of other languages) Other please specify English / Literacy (for English speakers) Maths / Numeracy 2

Section 4 Equal opportunities The College aims to promote equal opportunities for all students. Please answer these questions to help us monitor the service we are offering. This information will not be used in selecting students for courses. EQU What is your ethnic group? Please tick the box that best describes your ethnic group: Asian / Asian British 39. Indian 40. Pakistani 41. Bangladeshi 42. Chinese 43. Any other Asian background Other 47. Arab 49. Other mixed background 81. Kurdish 30. Turkish 98. Any other ethnic group Black / African / Caribbean / Black British 44. African 45. Caribbean 46. Any other black / African / Caribbean background Mixed / Multiple ethnic group 35. White and Black Caribbean 36. White and black African 37. White and Asian 38. Any other mixed / multiple ethnic background White 31. English/Welsh/Scottish/ Northern Irish/British 32. Irish 33. Gypsy or Irish Traveller 34. Any other White background Is English your first language? Yes No If no, what is your first/home language? Section 5 Residency What is your Nationality according to your passport(s)? What country were you born in? RES Have you lived in the UK or the European Economic Area (EEA) for the last 3 years? Yes If no what countries have you lived in during the last 3 years? Country From (DD/MM/YYYY) To (DD/MM/YYYY) No Is there any time limit on your stay in the UK? Yes No Are you an asylum seeker or a refugee? Yes No 3

If you hold a passport from outside the EEA please answer the questions below: If you are currently living / staying in the UK, do you have a visa? Yes No Please provide details below: Student Visa Visitor Visa Work Visa Student Visitor Visa Other, please specify Date your visa is valid from (DD/MM/YYYY) Date your visa is valid to (DD/MM/YYYY) Section 6 Education and qualifications (applicants aged 18 or under must complete this section) Name and address of the school or college you are/were attending in 2017/18. If you have left school, you need to write the details of your last school and the name of your current college/training provider/employer including dates. QUL Dates (mm-yyyy) From To School/College/Training Organisation Please list any qualifications you have, or expect to achieve, before you start at Westminster Kingsway College. If you are aged 18 or under, your tutor must fill in predicted grades. If you have already taken your exams you need to list your grades in the Grade Actual column. If English is not your first language, you must indicate which English language exams you have taken and passed. Subject level Qualification Month / Year Grade Predicted Actual Teacher Checked/ Verified e.g. English Literature 2 GCSE 06 / 2018 B All International students should enclose certified copies of their certificates/qualifications with their application. 4

Section 7 Personal statement (interests and careers plans) Please tell us why you have chosen the course(s) you are applying for, and what you hope to do afterwards. This is also your opportunity to tell us about your interests and hobbies and any experience you have that supports your choice of course. For example, part-time work, voluntary work or other courses you have taken in a similar subject. PER Section 8 Safeguarding Do you have any unspent criminal convictions? Yes No You do not have to tell us about any convictions that are spent (as defined by the Rehabilitation of Offenders Act 1974), or about any cautions, reprimands or final warnings. You must disclose all unspent convictions of any offence. For further advice about convictions are unspent please contact the NACRO helpline on 0800 0181 259. CC Do you have any relevant criminal convictions? Yes No Relevant means offences against a person, whether of a violent or sexual nature and convictions involving unlawful supplying of or possession of controlled drugs or substances. Declaring a conviction will not necessarily prevent you from being offered a place at College but failure to disclose something which we later become aware of could result in disciplinary action. Please note that some of our courses, such as care, child care or health studies, require you to disclose spent and unspent convictions, as well as cautions, reprimands and final warnings in the context of legislation on safeguarding children and vulnerable adults. 5

Section 9 Declaration and signature The College is registered under the Data Protection Act to hold information on applicants and has procedures to protect personal data. What we will do with the information on this form: We will store your details on our secure database so that we can contact you about the course you have applied for. I understand and agree that the college can process my data in order to make an application in accordance with the Data protection act. Yes No (If no we will not be able to process your application) We may also use your details to contact you about the College, its news and events. If you would prefer not to be contacted for this purpose please tick this box If you have given us information about a disability or a learning difficulty, the College will pass this information on to our Additional Learning Support Team who will work with you to make sure you are supported at college. European Social Fund (ESF) Match Funding: This activity has been directly or indirectly part-financed by the European Social Fund - helping develop employment by promoting employability, business spirit and equal opportunities and investing in human resources. I hereby confirm that the information I have provided is accurate to the best of my knowledge and I understand that this information will be used by the Westminster Kingsway College (this College forms part of the Capital City College Group) for admissions, enrolment and reporting purposes and that some information requested will be stored on computer. I also understand that placement on a course(s) is subject to meeting entry requirements and availability at enrolment. By signing this declaration I am confirming that the information I have provided is correct. I understand that I have applied for a course at Westminster Kingsway College (this College forms part of the Capital City College Group) Signature of applicant: Date: (DD/MM/YYYY) PLEASE NOTE: We require a reference for any applicant aged16 18 which needs to be completed by your school or other appropriate referee (not friend or family). Your application may not be considered until the reference form on the last page has been completed and submitted according to application deadlines. Please keep a copy of this form. Our courses are very popular - apply early to get the best chance of a place on the course you want. (Office use only) Screen/Initials: 6

Westminster Kingsway College Reference Form 2018-2019 (applicants aged 16-18 must obtain and submit a reference to the College) Applicants aged 16-18: completed application forms must include a fully completed reference, usually from a school or college form tutor, head of year or another teacher who knows you well. If you have left school you can ask an employer or connexions advisor to fill in this section. Please note we may be unable to process applications for those aged 16-18 without fully completed references from applicant s school or college. Applicant details (* mandatory fields) *First Name: *Surname: Does the applicant have: a SEN statement? *Date of birth: (dd/mm/yyyy) Moving On Plan / S139A Statement CAF/E-CAF Is the applicant in receipt of Free School Meals? Yes No Home situation: Living with a parent, guardian or family member In care Just left care Living in a hostel or homeless Alone in this country Looked After Child Not living with parent, guardian or family member Support Needs: English language Pastoral Medical Learning ESOL Dyslexia Please provide details of selected support needs: Disability Other Was the applicant receiving additional or targeted support from your staff or other agencies? Yes If yes, please give details and tell us what support they will need (including help with exams): No Qualifications: (to fully complete if you haven t already verified on the application form) Subject level Qualification Month / Year Grade Teacher Predicted Actual Verified e.g. English Literature 2 GCSE 06 / 2017 B 7

Suitability for the programme: Recommended course level for the applicant (based on predicted grades) Entry Level Level 1 Level 2 Level 3 Level 4 and above Punctuality Excellent Good Average Unsatisfactory Number of days late Out of Attendance Excellent Good Average Unsatisfactory Meeting deadlines Excellent Good Average Unsatisfactory Behaviour & Discipline ` Excellent Good Average Unsatisfactory Motivation Excellent Good Average Unsatisfactory Written communication Excellent Good Average Unsatisfactory Oral communication Excellent Good Average Unsatisfactory Quality of work Excellent Good Average Unsatisfactory Academic ability Excellent Good Average Unsatisfactory Ability to work on own initiative Excellent Good Average Unsatisfactory Attitude to school/work environment Excellent Good Average Unsatisfactory Teamwork Excellent Good Average Unsatisfactory Relationship with others (peers/teachers) Excellent Good Average Unsatisfactory If you have indicated unsatisfactory for any of the above, please provide details in the space below: Has the applicant ever been excluded or suspended? Yes No Please use the space below to make any comments e.g. strengths, achievements and where they need to improve: Referee Details: *Full name: *Position: *Telephone: *Email: *Signature: *Date: *Organisation name & address including postcode: Organisation Stamp: Please return this form to: Post: Registry (WKC), Centre for Business Arts and Technology, 444 Camden Road, London, N7 0SP Email: registryinfo@westking.ac.uk 8