Telford College Enrolment Form | Telford College of Arts and Technology

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Telford College Enrolment Form

Full time applications ONLY
For part time courses please call 01952 642237

About you

Next of Kin
Surname
First Name
Title
Date of Birth	(dd/mm/yyyy)
Home Address
Postcode
Home Phone Number
Mobile Number
Email Address
Gender	Male Female
Nationality
Have you lived in the UK for the last 3 years or more?	Yes No

Name
Relationship
Phone Number

Have you attended Telford College on a 14-16 programme?	Yes No

Course Details

Are you interested in a

Full-time course Apprenticeship

Please list your choices of Full-time or Apprenticeship area you are interested in:

	Full-time	Apprenticeship
1st Choice
2nd Choice
3rd Choice

Your Qualifications

Please list all the qualifications you are taking or already have. Please give the type of qualification, e.g. GCSE. Write your actual or expected grade for each subject. You may need to ask your tutor.

Subject	Type of exam	Expected Grade	Actual Grade	Date Achieved
English Lang.
English Lit.
Maths
Science
Art
Geography
History
D & T
ICT
French
German
RE
PE

Your Education

If you're 16-18 we will contact school for reference

Current Course
Name of school or College you are attending
If you are not in education please state your last school/College
Please include any other information you may feel relevant to this application

Equal Opportunities

The Corporation and staff at Telford College have an absolute commitment to promote equality and fairness in all College operations, to celebrate the diversity of its staff and student populations and prevent unlawful discrimination.

This information will help ensure that the College provision does not discriminate against people on any grounds and will not be used to identify you personally.

English/Welsh/Scottish/N.Irish/British	White and Asian	Any other Asian Background
Irish	Any Other Mixed/Multiple Background	African
Gypsy or Irish Traveller	Indian	Caribbean
Any other White Background	Pakistani	Other Black/African/Caribbean
White and Black Caribbean	Bangladeshi	Arab
White and Black African	Chinese	Any Other Ethnic Group

Learning Support

We want you to succeed at College. To help us provide any additional learning or personal support you may need, please tick the boxes which apply.

Sight difficulty	Emotional/behavioural difficulties	A Statement of Educational Need
Difficulty with hearing	Mental Health difficulty	Multiple disabilities
Mobility problems	Temporary disability after illness	Other
Physical Problems	Profound/complex difficulties	Aspergers Syndrome
No disability	Other Medical Condition	Difficulty with reading
Difficulty with writing

Do you require Wheelchair access? Yes No

Do you have any of the following:

Moderate learning difficulty	Dyscalculia	Multiple learning difficulties
Severe Learning Difficulty	Other learning difficulties	Other
Dyslexia	Autism Spectrum Disorder	No learning difficulty

Do you wish to discuss your needs with an appropriate member of staff before interview? Yes No

Do you have extra support at school? Yes No

If you wish to speak to our Learning Support Manager in confidence, please call 01952 642391

Are you a child in care? Yes No

Are you a care leaver? Yes No

Are you a carer for someone? Yes No

Do you live independently? Yes No

Are you a parent? Yes No

Criminal Convictions

Do you have any unspent criminal convictions? Yes No

A yes answer does not automatically exclude your application. Any information will be treated in a confidential manner and we may ask for further information.

Key Worker Contact	Name:	Phone:
Parent / Carer Contact	Name:	Phone:

About us

Where did you hear about Telford College? (Tick all that apply)

Shropshire Star	Existing Student	Bus Advert
Billboards	Careers Advisor	School
Radio	Website	Supermarket
Town Centre Stand	Know a current student	Football Ground
Telford Journal	Cinema	Other

Declaration

Data Protection

The information you give us on this form will be stored electronically and used by the College, which is registered under the Data Protection Act 1998. This data may be shared with other relevant government organisations.

I confirm that the information I give in this application is true.

I agree that the College can contact other organisations to obtain references as required for my application to be processed and if necessary invite representatives of the organisations involved in my education or are.

For information and guidance please call 01952 642237