When completed, please send to Admissions · Blackpool and The Fylde College · FREEPOST SCE155559 · Bispham Campus · Blackpool · FY2 0UR
YOUR DETAILS SURNAME
FIRST NAME(S)
TITLE
Mr
Mrs
Miss
GENDER
Male
Female
Ms
Other DATE OF BIRTH
D D
MM
Y Y Y Y
AGE AT 31/08/2014
HOME ADDRESS (including number and street)
TOWN
POSTCODE
NATIONAL INSURANCE NO.
MOBILE PHONE NUMBER
PLEASE STATE YOUR NATIONALITY
HOME PHONE NUMBER (including area code)
COUNTRY OF BIRTH (if non UK/EU)
EMAIL (We send important information via email) Yes
Have you been a permanent resident of the UK for the last three years?
D D
If No: Date of first entry to live in the UK
MM
No
Y Y Y Y
Do you have a disability, medical condition or learning difficulty?
Yes
No
Have you ever been in foster care, care of the Local Authority or supported by the Leaving Care Team?
Yes
No
Have you ever been convicted of a criminal offence (not including motoring offences) or have any ongoing offences?
Yes
No
Which local school/college have you attended in the past 3 years?
QUALIFICATIONS
PREDICTED
ACHIEVED
No qualifications
P
A
Completed/will have completed GCSE programme or equivalent
P
A
Full Level 1 in subject area you are applying for
P
A
Full Level 2 in subject area you are applying for
P
A
4 GCSEs grade D or equivalent
P
A
P
A
(please tick which best describes the HIGHEST qualifications you are predicted to achieve, or have already achieved)
4 GCSEs grade C or above
(inc English Lang.
Maths
Science
)
P
5 or more GCSEs grade C or above (including: English Lang.
Maths
Science
Art
Design/Graphics
Drama/Dance
Music
Photography
A )
A/S or A Levels or equivalent
P
A
HNC/HND, degree or equivalent
P
A
Other qualifications
PREDICTED
ACHIEVED
PREDICTED
ACHIEVED
COURSE DETAILS FULL-TIME COURSES Course name:
Level:
APPRENTICESHIPS What type of Apprenticeship do you want? (ie subject area)
Level:
If you already have an employer, and would like to study for an Apprenticeship with them, please give details below: Employer name:
Contact number:
CAREER/EMPLOYMENT GOAL Data Protection Blackpool and The Fylde College is registered under the Data Protection Act 1988. Information we process about you may be used for planning, analysis, marketing and any other purpose deemed necessary. Your information may also be shared with other official organisations such as your school and Local Education Authorities. Please contact the College Data Protection Officer (Tel: 01253 504 064) if you have any concerns about the use or accuracy of your information.
To the best of my knowledge, the information given is correct: SIGNATURE
APPLICATION FORM
DATE
D D
MM
Y Y Y Y