Surname

Title MrMrsMissMs

First Name

Address

Postcode

Telephone

Mobile

E-mail

Date of Birth (DD/MM/YYYY)

Age on 31st August (in the year of entry)

If under 18

Name of parent or guardian

Parent's home tel. number

Parent's mobile tel. number

 

Country of birth

1.2 Have you been permanently resident
in the UK/EU for the past 3 years? Yes (go to 1.3)  No (go to 1.4)

1.3 Do you require a visa to study? Yes (go to 1.4)  No (go to 2)

1.4 (i) Please give details of entry to the UK

(ii) How were you admitted to the UK?   Student Visa   Visitor   Refugee/asylum seeker    Other, please specify

2. Course details

I would like to apply for the following course:

Course name:

Course code:

3. Monitoring information

(This is for statistical purposes only. Please indicate to which group you feel you belong.)

11 Bangladeshi12 Indian
13 Pakistani14 Asian other
15 African16 Caribbean
17 Black other18 Chinese
19 Mixed, White and Asian20 Mixed, White and Black African
21 Mixed, White and Caribbean22 Other Mixed Background
23 White British24 White Irish
25 White other
Other - please state

4. Any learning difficulty, disability or health issue

To enable us to give you the support you need, please indicate any special requirements(this information is completely confidential, will not be shared with any third party and is intended to help us to help you).

DyslexiaBasic English
*DisabilityDeaf
ChildcareOther (please state)
*Please state nature of disability

5. Learning Agreement

This agreement is between the College and you, the learner, and is supported by all documents issued by the College in connection  with the provision of College services. The College shall bot be held responsible for any failure to provide any services as a result of circumstances  beyond its control.

I agree to Uxbridge College processin personal data contained in this form, or any other data which  Uxbridge College may obtain from me or other people, whilst I am a student. I agree to the processing of such data for any purposes  connected with my studies or my health and safety whilst on the premises or for any other legitimate reason.

Data protection Act 1998 - The information you provide on this form will be passed to the Learning and Skills Council (the LSC).  The LSC is responsible for funding and planning education and training for young people and adults in England, and is registered under  the Data Protection Act 1998. The information you provide will be shared with other organisactions for the purpose of administration, careers  and other guidance, and statistical and research puposes. Other organisations with which we will share information include, the Department for  Education and Skills, Connexions, Higher Education Statistics Agency, Higher Education Funding Council for England, educational institutions and  organisations performing research and statistical wok on behlaf of the LSC or its partners. The LSC is also a cofinancing organisation and uses  European Social Funds from the European Union directly or indirectly part-finance learning activities , helping develop employment by promoting  employability, business spitit and equal opportunities, and investing in human resources. Further information about partner organisations  and what they do may be found at http://www.lsc.gov.uk, and by following the links to data protection.

At no time will personal information be passed to organisations for marketing or sales purposes. From time to time students are approached  to take part in surveys by mail and phone which are aimed at enabling LSC and its partners to monitor performance, improve quality and plan future provision.

Tick this box if you do not wish to be contacted by the LSC or its partners in respect of  surveys and research. The LSC values your views on education or training which you receive, and will use these to help bring about  improvements for learners in England.