FULL–TIME & APPRENTICESHIP APPLICATION FORM
Please complete ALL sections of this form in BLOCK capitals.
COURSE REQUIRED (Please tick relevant box(s) (more than one route can be selected).
Name of Course/Occupational area
Please tick this box if you do not know which course you want to study
Title: Mr/Mrs/Miss/Ms Surname:
Forenames (in full):
Previous Surname (if changed):
Nationality: Date of Birth: Current Address:
Postcode: Email address: National Insurance No.: Home Tel No. (incl Code): Mobile:
Have you been living in the UK for the last 3 years? Yes No Normal country of residence: Date of arrival in UK/EU
NEXT OF KIN DETAILS
Title: Mr/Mrs/Miss/Ms Initials: Surname: Relationship to Applicant (parent,guardian,etc):
Daytime Tel No (incl area code): Mobile:
ADMIN USE ONLY
ASSESSMENT: DATE/TIME: INITIALS INTERVIEW: DATE/TIME INITIALS
DISABILITY AND ADDITIONAL SUPPORT
Stephenson College can offer a wide range of support to help students succeed on their course. We welcome students with disabilities and learning difficulties (including, for example, dyslexia, epilepsy, mobility difficulties and mental health problems).
If you consider that you may need some additional support, please complete the following questions:
Do you consider yourself to have a learning difficulty, disability or medical condition that may affect your studies? (eg. use a wheelchair, have dyslexia etc)
If YES, please specify the nature of your condition. This will help us to best assess your requirements.
Will you require any alternative arrangements to assist you at initial assessment/interview?
If you ticked yes, we will contact you to discuss.
I agree for relevant details above to be passed to appropriate College staff in order to assess possible support requirements.
(If undecided, say so, but also indicate where main interests lie)
EMPLOYMENT/WORK EXPERIENCE (Give details of any employment, full-time (F/T), part-time (P/T), Saturday
(S), work experience (WE)
Company Duties Date FT/PT/S/WE
CURRENT EMPLOYER (if applicable)
Contact Name Contact Number
NAME AND ADDRESS of present or last school/college attended (if within the last 3 years)
Have you ever been on another course at Stephenson College?
Yes No If yes, which course:
Date from to
EXAMINATION RESULTS AND PREDICTED GRADES (include GCSE, AS/A Level, Degree etc).
Predicted Result & Name of Examination Level Date of Exam Grade Grade 1 2 3 4 5 6 7 8 9 10 11
Please give the name and address of 2 referees (at least one should be academic from your school)
who may be contacted if required. You will be advised at interview if a reference is needed. Name
DATA PROTECTION – DATA PROTECTION ACT 1998
Stephenson College is registered as a Data User under the Data Protection Act 1998. Personal data is treated in confidence and will not be disclosed to a third party except where the College is required or permitted to do so by law or where the applicant has given consent in advance. The personal data collected on this form will be processed and held on a database in order to manage your application.
We may use such data for any purpose connected with your studies, health and safety whilst on the premises, or for any legitimate reason. This may include contacting you and your parent / guardian by post, email or telephone (incl SMS) from time to time in connection with your application.
From time to time the college may use your details to send you information.
Please tick here if you do not require this information
Do you have any previous spent or unspent criminal convictions (excluding traffic offences)?
If Yes, please give details (we may contact you to discuss further):
DECLARATION BY APPLICANT (Please read carefully)
I confirm that the details on this form are accurate and complete. If offered a place, I agree to comply with the College policies and procedures when using College facilities and understand that full copies of these policies and procedures are available from Student Services.
PLEASE RETURN THIS FORM TO:
Please attach a FREEPOST LE6547 passport sized photo Stephenson College here. Thornborough Road APPLICANTS FOR Coalville THE Leicestershire APPRENTICESHIP LE67 3TN PROGRAMME