Application for Full-Time Post-16 Education

• If the course has been advertised as starting in January would you prefer to start in January 2012 or September 2012?

  January September

Please let us know your course preference.

• Course Title
  change Code
  

• apply for another course
• Course Title
  change Code
  

• Are you a School Leaver or a Mature Student?

  School Leaver Mature Student (18+)

• Are you statemented?

  Yes No

• Title
  First Name(s)
  Surname
  
• Date of Birth (DD/MM/YYYY)
  
• Present or Previous School/College
  
  This is where we will ask for your confidential reference from. Date of Leaving
  
• Name and address of current or last employer (if applicable)
  
• Permanent Home Address
  
  Postcode
  
  Telephone Number
  Address for Correspondence (if different)
  
  Postcode
  
  Telephone Number
  
• Mobile Number
  
• Email Address
  
• Name of Parents/Guardians
  
• Emergency Contact Telephone Number(s)
  
  Daytime
  Mobile
  
• Normal Country of Residence
  
• Date of Entry to UK (if within last three years)
  Please state language spoken if English is not your first language
  
• Ethnic Origin
  ==PLEASE SELECT== English/Welsh/Scottish/Northern Irish/British Irish Gypsy or Irish Traveller Any other White background White and Black Caribbean White and Black African White and Asian Any other Mixed/Multiple ethnic group Indian Pakistani Bangladeshi Chinese Any other Asian background African Caribbean Any other Black/African/Caribbean background Arab Any other ethnic group Not known / Not provided
• Do you have a disability/medical condition? yes no
• Visual Impairment
  Dyslexia
  Hearing Impairment
  Physical Disability
  Learning Difficulty
  Mobility Difficulty
  Medical Needs (eg Diabetes). Please state the medical condition
• Are you prepared for the information to be forwarded to appropriate staff within the college? yes no
• If "no" would you like a confidential interview with the Additional Needs Support Tutor? yes no
• If you have any other student support needs please inform us at your interview.
  The College has a statutory requirement to collect this information on behalf of DCSF and DIVS.
• Do you have any unspent criminal convictions (other than minor motoring offences)? yes no
  
  (If you indicate that you have unspent criminal convictions your application will not be processed until you have completed a declaration of criminal convictions which will be posted to you.)

• Qualifications - Please list the qualifications already gained and examinations taken - please enter NA if not applicable.

Type of Exam (e.g. GCSE, BTEC, A Level etc.)	Subject	Awarding Body	Year to be taken or year taken	Predicted grade	Actual Result (if applicable)
add more qualifications

Other qualifications (including sports awards, music, Duke of Edinburgh, etc.)	Results	Date
add more qualifications

• Please tick this box to agree to this form being processed

• (We will send this form to your school/college's careers co-ordinator or tutor to complete a confidential reference for you.)

• If you are under 18 please get your Parent/Guardian to tick this box to agree to this form being processed.
• Please tick this box if you do not wish to be contacted in respect of surveys and research by mail for phone.
• Please tick this if you do not wish to be contacted about courses or learning opportunities by post.

• Please type the two words shown below into the box provided. Why?

  This is a quick test that you are human and applying to BCOT and not an automated programme trying to send out spam and false applications.

All applicants will be required to supply a reference and attend an Advice and Guidance meeting with curriculum specialists. An offer of a place at the college will be discussed at this meeting.

The information collected on this form will be used to process your application for a full-time place at this College & may be used for statistical analysis. The College is registered under the Data Protection Act 1998. A copy of our data protection policy is available here.

Basingstoke College of Technology recognises that all members of the College community are of equal value, irrespective of gender, ethnic origin, class, age, marital status, disability, religion, sexual orientation or any other perceived difference. As such they are entitled to be treated fairly and without prejudice in every aspect of College life.