City Westminster and Islington Kingsway College College Application for 2018 2017 //18 This This College forms part part of of the the Capital City City College Group If If you you require a a copy in an alternative format please email the the Course Information Team: Team: courseinfo@capitalccg.ac.uk or call 020 7700 9200 Please download and save this form to your computer before completing. Office Use Only Reference Number Interview Support International Did Please you complete know you in BLOCK can submit CAPITALS your application using BLACK online? or Visit BLUE http://www.candi.ac.uk/apply-enrol/how-apply INK and keep a copy for yourself. Please Return completed in application BLOCK and CAPITALS reference form(s) using to: BLACK Registry (WKC), or BLUE Centre INK for and Business keep Arts a copy and for Technology, yourself. Return 444 Camden completed Road, London, application N7 0SP and reference form(s) to: Central Admissions Team, 383 Holloway Road, Section 1 Your personal details The Please Marlborough enter your name Building, as it appears CHSCC, on London, official documents: N7 0RN. Please enter your name as it appears on official documents: Family Name/Surname Title: Mr Mrs Ms Miss Other Family Name/Surname Title: Mr Title: Mrs First Mr Miss Name(s): Mrs Ms Other Miss Ms Other Male Female First Name(s): Date of Birth (DD/MM/YYYY) Age on 31 August 2017 Male Female Unique Learner Number - ULN (if known) Date of Birth (DD/MM/YYYY) Age on 31 August 2018 Unique Current Learner Home Address Number - ULN (if known) Current Home Address Country Tel Tel Country: (Mobile) Email Address Email Address Postcode Postcode Tel Tel (Home) (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 1 2 1 2 1 2 1 2 1 2 Applicants aged 16-18: the reference form at the back of the application must be completed by your school or college 1 and submitted to us before your application can be considered. Office Use Only AG Surname/Family Name First Name(s) Reference Number
Section 3 Additional support Section 3 Additional support The College welcomes applications from learners of all abilities and we are committed to supporting applicants through the The admissions College welcomes process. applications To ensure that from we learners provide of you all with abilities the and best we support are committed available, to please supporting indicate applicants any learning through difficulties, the admissions disabilities process. or To support ensure requirements that we provide that you will with need the best at your support interview. available, please indicate any learning difficulties, disabilities or support requirements that you will need at your interview. Learning Difficulties Learning Difficulties 10. Moderate learning difficulty 11. 10. Severe Moderate learning learning difficulty difficulty (e.g. Dyspraxia) 14. (e.g. Autism Dyspraxia) spectrum disorder 12. 11. Dyslexia Severe learning difficulty 00. 14. No Autism learning spectrum difficulty disorder 13. 12. Dyscalculia Dyslexia 98. 00. I No do learning not wish difficulty to give this information 94. 13. Other Dyscalculia specific learning difficulty 96. 98. Other I do not Please wish to specify give this information 94. Other specific learning difficulty 96. Other Please specify (e.g. Dyspraxia) Disabilities / Medical Conditions Disabilities / Medical Conditions 04. Visual impairment 05. 04. Hearing Visual impairment 07. Profound/complex disabilities 06. 05. Disability Hearing impairment affecting mobility 15. 07. Asperger Profound/complex syndrome disabilities 93. 06. Other Disability physical affecting disability mobility 01. 15. Serious Asperger visual syndrome impairment 95. 93. Other medical physical condition disability 02. 01. Hearing Serious aid visual user impairment (e.g. 95. Other epilepsy, medical asthma, condition diabetes) please specify 00. 02. Wheelchair Hearing aid user (e.g. epilepsy, asthma, diabetes) please specify 09. 00. Mental Wheelchair health user difficulty 09. Mental health difficulty 97. Other please specify 08. Social and emotional difficulties 97. Other please specify 17. 08. Speech, Social and language emotional and communication difficulties needs 16. 17. Temporary Speech, language disability and after communication illness needs 98. I do not wish to give this information (e.g. 16. Temporary post-viral) or disability accident after please illness describe 03. 98. No I do disability not wish to give this information (e.g. post-viral) or accident please describe 03. No disability Are you living in the care of social services, leaving care services or living in any type of hostel accommodation? Are you living in the Yes care of social No services, leaving care services or living in any type of hostel Applicants accommodation? aged Yes 14-16: Have you No been adopted from care and/or on a Special Guardianship or Residence Order? Applicants Yes aged No 14-16: Have you been adopted from care and/or on a Special Guardianship or Residence Applicants Order? Yes aged No 14-19: did you receive Free School Meals in 2017-18 (September 2017 to June 2018)? Yes Applicants No aged 14-19: did you receive Free School Meals in 2016-17 2017-18 (September 2016 2017 to June 2017)? 2018)? Will Yes you No need additional support at interview for your disability/learning difficulty, for example a communication Will you need additional support worker support if at you interview are deaf? for Yes your disability/learning No difficulty, for example a If communication yes, please specify support what worker you will if need you are below deaf? Yes No If yes, please specify what you will need below SUP SUP Please let us know if you think you may need help while you are at the College. ESOL Please (English let us know for Speakers if you think of other you may languages) need help while Other you are at please the College. specify English ESOL (English / Literacy for (for Speakers English of speakers) other languages) Other please specify Maths English / / Numeracy Literacy (for English speakers) please specify Maths / Numeracy 2 2 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. What is your ethnic group? Please tick the box that best describes your ethnic group: EQU 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? Have you lived in the UK or the European Economic Area (EEA) for the last 3 years? Yes No RES If no, what countries have you lived in during the last 3 years? Country From (DD/MM/YYYY) To (DD/MM/YYYY) Is there any time limit on your stay in the UK? Yes No Are you an asylum seeker or a refugee? Yes No 3 3
Is there any time limit on your stay in the UK? Yes No Are you an asylum seeker or a refugee? Yes No 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: If you hold a passport from outside the EEA please answer the questions below: Student Visa Work Visa If you are currently living/staying in the UK, do you have a visa? Yes No Visitor Visa Student Visitor Visa If you hold a passport from outside the EEA please answer the questions below: Please provide details below: Other, please specify If you are currently living/staying in the UK, do you have a visa? Yes No Student Visa Work Visa Please provide details below: Visitor Visa Student Visitor Visa Student Other, Date your Visa please visa specify valid from (DD/MM/YYYY) Work Date Visa your visa is valid to (DD/MM/YYYY) Visitor Visa Student Visitor Visa Other, please specify Name and address of Date your visa 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 Date the school your and address visa or college valid of from the you school (DD/MM/YYYY) are/were or college attending you Name are/were in 2017/18. and attending address If you in have 2016/17. Date left your school, If you visa have you is valid need left to school, to (DD/MM/YYYY) write you the need details to of of write your last the school details and of your the last name school of your and current the name college/training of your current provider/employer college/training including provider/employer dates. including dates. Section 6 Education and qualifications (applicants aged 18 or under must complete this section) Dates (mm- yyyy) School/College/Training Organisation Name and address of From To 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. Section 6 Education and qualifications (applicants aged 18 or under must complete this section) the Dates school (mm- yyyy) or college you are/were School/College/Training attending 2017/18. If Organisation you have left school, you need to write the details of your From last school and To the name of your current college/training provider/employer including dates. Please list any qualifications you have, or expect to achieve, before you start at at Westminster City and Islington Kingsway College. College. If If you Dates are (mm- yyyy) aged 18 or under, your tutor School/College/Training must fill fill in predicted grades. Organisation If If you you have already taken your your exams you you need to need From list to your list grades your grades To in the in Grade the Grade Actual Actual column. column. QUL QUL QUL QUL If English is not your first language, you must indicate which English language exams you have taken and passed. Please list any qualifications you have, or expect to achieve, before you start at City and Islington College. If you Subject are aged 18 or under, your tutor Level must fill in Qualification predicted grades. Month If you / Year have already Grade taken your exams Teacher you need to list your grades in the Grade Actual column. Checked/ Predicted Actual Please list any qualifications you have, or expect to achieve, before you start at City and Islington College. Verified If you If English e.g. are English aged is not Literature 18 your or under, first language, your tutor you 2 must must fill indicate GCSE predicted which grades. English 06/2017 If / language 2018 you have exams already B you taken have your taken exams and passed. ü you need Subject to list your grades in the Grade Level Actual Qualification column. Month / Year Grade Teacher Checked/ If English is not your first language, you must indicate which English language Predicted exams you Actual have taken and passed. Verified Subject e.g. English Literature Level 2 GCSE Qualification Month 06 / 2018 / Year B Grade Teacher ü Checked/ Predicted Actual Verified e.g. English Literature 2 GCSE 06 / 2018 B ü 4 4 All International students should enclose certified copies of their certificates/qualifications with their application. 4 4
Section 7 Personal statement (interests and careers plans) 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. Please This is tell also us your why you opportunity have chosen to tell the us course(s) about your you interests are applying and hobbies for, and and what any you experience hope to do you afterwards. have that This supports is also your your choice opportunity of course. to tell For us example, about your part-time interests work, and voluntary hobbies and work any or experience other courses you have you that have supports taken in your a similar choice subject. of course. For example, part-time work, voluntary work or other courses you have taken in a similar subject. PER PER Section 8 Safeguarding Section 8 Safeguarding Do you have any unspent criminal convictions? Yes No 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 You Offenders do not Act have 1974), to tell or us about any any cautions, convictions reprimands that are spent or final (as warnings. defined by You the must Rehabilitation disclose all of unspent Offenders convictions Act of 1974), any offence. or about For any further cautions, advice reprimands about convictions or final warnings. are unspent You please must contact disclose the all unspent NACRO convictions helpline on of 0800 any offence. 0181 259. For further advice about convictions are unspent please contact the NACRO helpline on 0800 0181 259. Do you have any relevant criminal convictions? Yes No 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. 5 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. CC CC 5 Section 9 Declaration and signature
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 City Westminster and Islington Kingsway College College (this College (this College forms forms part of part the 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 City Westminster and Islington Kingsway College College (this College (this College forms forms part part of the Capital City College Group) Signature of applicant: Date: (DD/MM/YYYY) Type in your full name 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. Email this form to your referee (this is from your school or college form tutor) (Office use only) Screen/Initials: 6
Applicants (applicants aged aged 16-1816-18: must obtain completed and submit application a reference to forms the College) 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. Westminster City and Islington Kingsway College College Reference Reference Form Form 2018-2019 2017-2018 2018-2019 Please (applicants note we are unable to process applications for those aged 16-18 without fully completed references aged 16-18 must obtain and submit a a reference to to the the College) from the applicant s school or college. For A Levels, we will need to receive a fully completed application and reference form by the relevant deadline date please contact us to find more information on deadline dates (onlineapps@candi.ac.uk or onlineapps@capitalccg.ac.uk). Applicants aged 16-18: completed application forms must include a fully completed reference, usually from Applicant details (* mandatory fields) a school or college form tutor, head of year or another teacher who knows you well. If you have left school you *First can Name: ask an employer or connexions advisor to fill in this section. *Date of birth: (dd/mm/yyyy) Please *Surname: note we are may unable be unable to process to process applications applications for those for those aged aged 16-18 16-18 without without fully fully completed completed references references Applicant details (*mandatory fields) details (* mandatory fields) from the applicant s applicant s school school or college. or college. For A Levels, we will need to receive a fully completed application and reference Does *First Name: the form applicant by the relevant have: deadline a SEN statement? date please contact Moving us On *Date to find Plan of more / birth: S139A information Statement on deadline CAF/E-CAF dates Applicant details (* mandatory fields) (onlineapps@candi.ac.uk or onlineapps@capitalccg.ac.uk). (dd/mm/yyyy) Is *Surname: *First the Name: applicant in receipt of Free School Meals? Yes No *Date of birth: Applicant details (* mandatory fields) (dd/mm/yyyy) *Surname: Home Does the situation: applicant Living have: with a a SEN parent, statement? guardian or family Moving member On Plan / S139A In Statement care Just CAF/E-CAF left care *First Name: *Date of birth: Living Is the applicant in a hostel in or receipt homeless of Free Alone School in Meals? this country Yes Looked No (dd/mm/yyyy) After Child *Surname: Does the applicant have: a SEN statement? Moving On Plan / S139A Statement CAF/E-CAF Not living with parent, guardian or family member Is Home the applicant situation: in receipt Living of with Free a School parent, Meals? guardian Yes or family No member In care Just left care Does Support the Needs: applicant have: a SEN statement? Moving On Plan / S139A Statement CAF/E-CAF Living in a hostel or homeless Alone Alone in this in this country country Looked Looked After Child After Child Is Home English Not the living applicant language situation: with in parent, receipt Living guardian of with Free or a School parent, family Meals? member guardian Learning Yes or family No member In care Disability Just left care Living Pastoral in a hostel or homeless Alone in this ESOL country Looked After Child Other Home Not Support living situation: with Needs: parent, Living guardian with or a parent, family member guardian or family member In care Just left care Living English in Please language a hostel provide details or homeless Alone in this of selected support Learning country needs: Looked After Child Disability Not Support Pastoral living with Needs: parent, guardian or family member ESOL Other English Medical language Learning Dyslexia Disability Support Please Pastoral Was the provide applicant Needs: details receiving of selected additional support needs: or targeted ESOL support from your staff or other agencies? Other Yes English Please provide details of selected support needs: If yes, please language give details and tell us what support Learning they will need (including help with exams): Disability No Pastoral Medical ESOL Dyslexia Please provide details of selected support needs: Other Was the applicant receiving additional or targeted support from your staff or other agencies? Yes No Medical If Please yes, please provide give details of and selected tell us support what support Dyslexia needs: they will need (including help with exams): Was Qualifications: the applicant receiving (to fully complete additional if or you targeted haven t support already from verified your on staff the application or other agencies? form) Yes No Medical If yes, please give details and tell us what support Dyslexia they will need (including help with exams): Was the applicant receiving additional or targeted support from your staff or other agencies? Yes No 7 If Qualifications: yes, please give details (to fully and complete tell us what if you support haven t they already will need verified (including on the application help with exams): form) 7 Subject Level Qualification Month / Year Grade Teacher Qualifications: (to fully complete if you haven t already verified on the application form) 7 Verified Predicted Actual Qualifications: Subject e.g. English Literature (to fully complete Level 2 if you haven t GCSE Qualification already verified on the Month 0606/2017 application / 2018 / Year form) B Grade Teacher ü Verified Predicted Actual e.g. English Literature 2 GCSE 06 / 2018 B 7 ü Suitability for the programme: Recommended course level for the applicant (based on predicted grades) Suitability for the programme: Entry Level Level 1 Level 2 Level 3 Level 4 and above Recommended course level for the applicant (based on predicted grades) 7
Suitability for the programme: Recommended Suitability for course the programme: level for the applicant (based on predicted grades) Entry Recommended Level course Level 1 level for the applicant Level (based 2 on predicted Level grades) 3 Level 4 and above Punctuality Entry Level Level 1 Level 2 Excellent Good Level 3 Average Level 4 and above Unsatisfactory Number of days late Out of Punctuality Excellent Good Average Unsatisfactory Attendance Excellent Good Average Unsatisfactory Number of days late Out of Meeting deadlines Excellent Good Average Unsatisfactory Attendance Excellent Good Average Unsatisfactory Behaviour Meeting deadlines & Discipline ` Excellent Excellent Good Good Average Average Unsatisfactory Unsatisfactory Motivation Excellent Good Average Unsatisfactory Behaviour & Discipline ` Excellent Good Average Unsatisfactory Written communication Excellent Good Average Unsatisfactory Motivation Excellent Good Average Unsatisfactory Oral communication Excellent Good Average Unsatisfactory Written communication Excellent Good Average Unsatisfactory Quality Oral communication of work Excellent Excellent Good Good Average Average Unsatisfactory Unsatisfactory Academic ability Excellent Good Average Unsatisfactory Quality of work Excellent Good Average Unsatisfactory Ability to work on own initiative Excellent Good Average Unsatisfactory Academic ability Excellent Good Average Unsatisfactory Attitude Ability to to work school/work on own initiative environment Excellent Excellent Good Good Average Average Unsatisfactory Unsatisfactory Teamwork Excellent Good Average Unsatisfactory Attitude to school/work environment Excellent Good Average Unsatisfactory Relationship with others (peers/teachers) Excellent Good Average Unsatisfactory Teamwork Excellent Good Average Unsatisfactory If you have indicated unsatisfactory for any of the above, please provide details in the space below: 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 Has the use applicant the space ever below been to excluded make any or comments suspended? e.g. strengths, Yes No achievements and where they need to improve: Please use the space below to make any comments e.g. strengths, achievements and where they need to improve: Referee Details: *Full Referee name: Details: *Position: *Full Referee name: Details: *Position: *Full name: *Signature: *Position: *Signature: Please *Signature: type in your name as your electronic signature *Telephone: *Telephone: *Email: *Telephone: *Email: *Date: *Email: *Date: *Date: 8 *Organisation *Organisation name name & address address including including postcode: postcode: Organisation Organisation Stamp: Stamp: Please Please return return this this form form to: to: Post: Post: Registry Central Admissions (WKC), Centre Team, for 383 Business Holloway Arts Road, and Technology, The Marlborough 444 Camden Building, Road, CHSCC, London, London, N7 0SP N7 0RN Email: Email: registryinfo@westking.ac.uk onlineapps@candi.ac.uk or onlineapps@capitalccg.ac.uk 8