halesowen college application form … · halesowen college please complete this form clearly and...
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HALESOWEN COLLEGE Please complete this form clearly and accurately using BLOCK CAPITALS OR if you prefer apply online at www.halesowen.ac.uk
RETURN TO: Admissions, HALESOWEN COLLEGE Whittingham Road, Halesowen, West Midlands B63 3NA
Student ID No.(for office use only)
PART 1: IMPORTANT INFORMATION ABOUT YOU AND YOUR COURSELast name First name Date of Birth
Address
Postal Code
Phone - Home Mobile Email address
Are you already attending Halesowen College? Yes No
Name and brief address of Schools/Colleges last attended Leaving Date(Please indicate all Schools/Colleges attended since Year 7, including any attended after Year 11)
If you are not a Year 11 student have you taken any qualifications since leaving school? Yes No
Course Grade
Note - Information will be used to process your course enrolment and will be held and processed in accordance with the College’s Data Protection Policy.We may contact you from time to time regarding future College events and new courses. If you would prefer not to be contacted please tick this box
Course Grade
APPLICATION FORMAdmission 2018-2019
Box 3 - Work Based Learning (Learning Apprenticeships)
Box 2 - Vocational courseBox 1 - A Level Subjects - please give subjects
COURSE APPLIED FOR AT HALESOWEN COLLEGE - Please complete 1 box OR
(see page 89-98) Yes OR
Do you wish to be considered for Enhanced A Level Pathways Yes No Subject
please tick appropriate box
Subjects to be taken in Year 11 (or already achieved) Level Subjects already taken Year ResultsList all subjects (H/I/F) before Year 11 Taken (if known)
PERSONAL STATEMENT:Tell us about yourself and why you have applied for this option (attach a separate sheet, if you wish)
Do you have a learning difficulty? Yes No
SUPPORT NEEDS - (including disabilities or learning difficulties) IMPORTANT: ALL applicants should complete this sectionDo you have any support at school to assist you in your learning? Yes No If YES give details
Do you receive any special arrangements for taking examinations, eg extra time, Scribe or Reader Yes No
WE WOULD LIKE TO GIVE YOU THE SUPPORT YOU NEED TO ATTEND OUR CLASSES. Please tick any of the boxes below, if they describe you
Information of this nature will be passed to the Learning Support Manager who will contact you to discuss your support needs
PERSONAL AND EQUAL OPPORTUNITIES INFORMATION:
Gender: Male FemaleNationality
How long have you lived at your current address?If less than 3 years - previous address:
Have you been resident in the UK or a European Union country for at least the last 3 years? Yes No
If No, please complete this section and enclose any supporting documents state date of entry to UK and where you have been resident:Are you and your family seeking asylum in the UK? Yes NoWhat was your date of entry to the UK?Do you have the Right of Abode or Indefinite Leave to enter and remain in the UK Yes No
PART 2: INFORMATION WE NEED FOR OUR RECORDS
What is your ethnic group? Choose the option that best describes your ethnic group or background
English/Welsh/Scottish/Northern Irish/British (31)Irish (32)Gypsy or Irish Traveller (33)Any Other White Background (34)White and Black Caribbean (35)White and Black African (36)White and Asian (37)Any other mixed/Multiple Ethnic background (38)Indian (39)
Pakistani (40)Bangladeshi (41)Chinese (42)Any other Asian background (43)African (44)Caribbean (45)Any other Black/African/Caribbean background (46)Arab (47)Any other ethnic group (98)
ETHNICITY
Are you in receipt of Free School Meals? Yes No
Have you applied to any other College or 6th Form? Yes NoIf YES please specify
I confirm that I have read and understood the statement about personal and sensitive data in the College Prospectus and am happy to comply with this as part of my applicationApplicant’s Signature Date
Signature of Parent or Guardian (if under 18) DateAs soon as we receive your application, your school/college will be contacted for a reference, predicted grades and support required to assist your learning (if appropriate).
Have you had any Careers Advice? Yes NoHave you attended an Open Day at Halesowen College? Yes No
PART 3: DATA PROTECTION ACT 1998 AND SIGNATURES
Are you currently in care? Yes No
Do you have a Disability/Health/Medical Condition? Yes No
Asperger’s Syndrome (10)Moderate learning difficulties (01)Severe learning difficulties (02)Dyslexia (11) Multiple Disabilities (90)Other specific learning difficulties (19)Autism spectrum disorder (20)Multiple learning difficulties (90)Other (97)
Visual impairment i.e. difficulty seeing (01)Hearing Impairment i.e. difficulty hearing (02)Disability affecting mobility i.e. difficulty moving (03)Other physical disability (04)Other medical conditions e.g. epilepsy, asthma, diabetes (05)Emotional/behavioural difficulties (06) Mental iIl health (07) Temporary disability i.e. broken leg or arm (08)Profound or complex disability (9)
If YES please tick the appropriate box(es) below: If YES please tick the appropriate box(es) below:
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