Application Form

Your Details:

Mr:

Miss:

Ms:

Mrs:

Other:

Surname:

First Name(s):

Address:

Postcode:

Home Tel:

Mobile Tel:

Email:

Date of Birth:

National Insurance Number:

Nationality:

Country of Residence(Last 3 Years):

Which school or college did you last attend?:

Ethnic Origin (to be used for equal opportunities monitoring purposes only):

Bangladeshi:

Indian:

Pakistani:

Other - Asian:

Black - African:

Black - Caribbean:

Black - Other:

Chinese:

Mixed - White and Asian:

Mixed - White and Black African:

Mixed - White and Black Caribbean:

Mixed - Other:

White - British:

White - Irish:

White - Other Background:

Other:

Prefer not to say:

Do you have a disability?:

Yes:

No:

If Yes, please tick which applies to you:

Visual Impairment:

Hearing Impairment:

Disability affecting mobility:

Other physical disability:

Other Medical Condition:

Emotional / Behavioural Difficulties:

Mental Health Difficulty:

Temp Disability After Illness/Accident:

Profound / Complex Disability:

Aspergers Syndrome:

Multiple Disabilities:

Other:

 

Do you have a learning difficulty?:

Yes:

No:

If Yes, please tick which applies to you:

Moderate Learning Difficulty:

Severe Learning Difficulty:

Dyslexia:

Dyscalculia:

Other Specific Learning Difficulty:

Autism Spectrum Disorder:

Multiple Learning Difficulties:

Other:

 

 

To help us support your needs, please supply further information about your disability/learning difficultly (if applicable):

I heard about the College and the course I'm applying for from (please tick):

Friends/Family:

Connexions:

School:

Boston College Staff:

Newspaper:

The Course Brochure / Prospectus:

Job Centre/Employment Office:

Website:

Radio:

Other:

COURSE DETAILS

What career, if any, do you have in mind?:

Which course or subject areas interest you? (see prospectus):

First Choice:

Second Choice:

Which level of course would you like to study?:

A/AS Levels:

Higher Education Access:

Apprenticeship:

Advanced Apprenticeship:

First Diploma:

National Certificate:

National Diploma:

Foundation:

NVQ:

Other:

Not Sure:

If you are unsure about qualifications, courses or your career, would you like a general guidance interview?:

Yes:

No:

Please give additional information to support your application. Include details of any relevant work experience, any Key Stage Four courses (including venue/School and subjects), taster days, open days or any other activities that may be relevant. Please also tell us why you are interested in the course you are applying for:

Please make sure you give details of all qualifications and training you have undertaken. If you are still at school or College, please ask your tutor to complete this section. If you have left school please complete it yourself:

Qualification (eg. A-level, BTEC)	Date	Subject	Grade Achieved or Predicted

If you are at school/college please ask your tutor to comment on your suitability for a college course:

Attendance(As a percentage):

Ability & Effort:

General Comments:

School/College:

Teacher/Tutor:

Date:

IMPORTANT! PLEASE READ AND COMPLETE BEFORE SUBMITTING YOUR FORM:

DATA PROTECTION

Boston College is registered under the Data Protection Act and collects information about prospective learners for legitimate purposes only, in accordance with the Data Protection Act 1998.

This may include:

• Communicating with you regarding your application or enquiry
• Our internal administration
• Communicating with you regarding our courses and services generally
• Providing it to other parties as required by you or by law. These may include persons outside the European Economic Area. At no time will your personal information be passed on to organisation for marketing or sales purposes

We value your views on the service you receive from us. We may conduct surveys or research which will help us maintain or improve our service. Please tick here if you do not wish to be contacted to take part in this research:

Boston College may wish to contact you from time to time about courses or learning opportunities relevant to you. Please tick here if you do not wish to be contacted about courses or learning:

May we share your details, in confidence, with Connexions, who are committed to the same Data Protection policies as Boston College?

UNSPENT CRIMINAL CONVICTIONS

Do you have any unspent criminal convictions, cautions, reprimands or final warnings? You should not include any motoring offence for which the penalty was no greater than a fine and/or three penalty points. If you tick the ‘Yes’ box, the College may ask you for further details.

Yes:

No:

If you do not tick either box, your application will not be processed.

Please note that if you are convicted of a criminal offence while your application is being processed, you should notify the College immediately.

EQUAL OPPORTUNITIES

Boston College is committed to equal opportunities and positively welcomes applications from individuals irrespective of racial origin, age, gender, sexual orientation, religious faith or disability.

Please ensure you have completed all sections to avoid your application being delayed. When you have completed the form, please sign and return.

If you are applying for an Apprenticeship, by signing below you confirm that we can forward your details to potential employers.

SIGNED: _____________________________________

DATE: _______________________________________

Please return to: Boston College, FREEPOST PE867, Boston, PE21 6BR