Full Time / Part Time Application Form

*Course applying for:

Reserve choice of course:

Year of entry:

Title:

*First Name:

*Last Name:

*Home Address:

Town:

County:

*Postcode:

*Telephone:

Current Address (if different):

Town:

County:

Postcode:

*Date of birth:

Nationality:

If overseas, date of entry into the UK:

Are you in the armed forces?: Yes No

Marital Status:

Name of parent/guardian:

Relationship to student if not parent:

Name and address of last school or college:

Town:

County:

Postcode:

Date of leaving:

Do you require support in the following?: Numeracy/Maths:

Literacy/English:

Study Skills :

Welfare Support:

Dyslexia Support:

Dyslexia Assesment:

Communicator Support:

Teacher of the deaf support:

Special exam arrangements:

Other (please specify):

How did you hear about Easton College?:

Examination Successes/Expected Grades

Subject	Exam Board	Level	Date	Grade/Result/Expected Result

Other relevant qualifications:

Grants and Awards:

Practical Experience (with dates)

Employers name and address	Dates	Nature of work experience

Have you previously attended a WBL/New Deal programme?:

Yes No

Have you previously attended a course at this college?:

Yes No

If yes, please state course and dates:

Declaration

Some of the information given on this form may be sent to the Department for Education and Employment, and the Learning and Skills Council, which is registered under the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data but it also allows the council to share information with other organisations for the purpose of detecting fraud. Further information about data confidentiality is available on request from the institution to which you are applying. I agree to the processing of any data the college may receive from me.

Equal Opportunities

The college regards all of its existing and potential members, both staff and clients, as being of equal value and will strive to promote equality of access and opportunity to all its classes and facilities.

I declare these particulars are correct, and I undertake, if admitted as a student, to comply with the terms and conditions of enrolment. *