Section 1: About yourself

First names: Family name:

Gender: £ Male £ Female £ Mx:  £ Mr £ Mrs £ Miss £ Ms £ Mx:

Address line 1:

Address line 2:

Town/City:

County/State:

Postcode/Zip code: Country:

Age: Date of birth: DD / MM / YYYY Primary phone number:

Mobile number: Email:

I would like to be contacted by: £email £post

Emergency contact details (to be completed by all applicants). This must be your parent/carer if you are under 18

Relationship to applicant:

First name: Last name:

£ Mr £ Mrs £ Miss £ Ms £ Mx:

Address:

Primary phone number: Secondary phone number:

Email:

Section 2: Your programme choice

Do you require advice and guidance to help you choose the right programme? £ Yes £ No

If so, we will get in touch to arrange a careers consultation.

Programme title:

If you are applying for A-levels, please list your chosen subjects:

In which year would you like to start your programme?

If you are applying for an apprenticeship please answer below. If not, please move to section 3

£  I already have a job. Name of employer:

£  I have a job lined up. Name of employer:

£  I need help finding a job Job title:

Where are you going to learn? Banbury and Bicester College City of Oxford College Reading College

ATG Training In the workplace (Activate Apprenticeships)

Please complete in block capitals and in BLACK INK

Office use - Student ID no:

APPLICATION FORMINFORMATION FOR CUSTOMERSIf you would like any part of this document explained, translated or provided in another format such as large print, audio or Braille, please contact Advice and Admissions on 0800 612 6008. Please note our website has accessibility functions, allowing you to adjust the size of the text and colour of the background.

You can also apply online at: www.banbury-bicester.ac.ukwww.cityofoxford.ac.ukwww.reading-college.ac.ukwww.atg-training.co.uk

Section 3: Your previous education

If you are a current/previous student at an Activate Learning college please tick £

Name and address of current school:

Dates attended:

Qualifications: Please list those already achieved and those for which you are currently studying. If you are awaiting the result of any examinations, please enter your predicted result.

Level (eg GCSE,

Level 2, Standard

12)

Subject Year Result Predicted Actual

Level (eg GCSE,

Level 2, Standard

12)

Subject Year Result Predicted Actual

Section 4: Your future plans

Please tell us why you want to do the programme and what you want to progress to.

Section 5: Extra support for you

We welcome all students and offer support with disabilities, medical conditions and language and learning support needs. Please answer the questions below so we can make the right arrangements for you.

A member of our support team will contact you for a confidential discussion if you select a disability/learning difficulty below.

1. Do you have a Statement of Special Educational Needs or an Education Health and Care Plan? £ Yes £ No

2. Do you consider yourself to have:

 

  

3. Would you like any access arrangements at interview, such as an interview room on the ground floor, a signer or a hearing loop? £ Yes £ No

Please provide details here:

£ No disabilities/learning difficulties4 £ Visual impairment5 £ Hearing impairment6 £ Disability affecting mobility93 £ Other physical disability95 £ Other medical condition, eg epilepsy, asthma8 £ Social and emotional difficulties

9 £ Mental health difficulty16 £ Temporary disability after illness or accident7 £ Profound complex disabilities15 £ Asperger syndrome97 £ Other disability (please state)

17 £ Speech, language and communication needs10 £ Moderate learning difficulty11 £ Severe learning difficulty12 £ Dyslexia13 £ Dyscalculia94 £ Other specific learning difficulty14 £ Autistic spectrum disorder

Section 6: How did you first hear about us?

£ Agent/representative

£ Billboard poster advert

£ British Council

£ Bus advert

£ Campus roadside banner

£ Careers fair or event

£ Careers/Connexions advisor

£ College website

£ Email

£ Employer

£ Family/Friend

£ Mailing sent to your home

£ Newspaper advert

£ Printed college prospectus

£ Printed flyer

£ Radio advert

£ School

£ Social Media (Facebook/Twitter etc)

£ Web banner advert

£ Web search

£ Other (Please specify)

Section 7: Extra information about yourself

ETHNICITY: We ask this as we want to ensure that our courses are accessed by people from all backgrounds

£ 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 background

£ Indian

£ Pakistani

£ Bangladeshi

£ Chinese

£ Any Other Asian background

£ African

£ Caribbean

£ Any Other Black / African / Arab

£ Any Other ethnic group

£ Information refused

CRIMINAL CONVICTIONS: This part of the form MUST be completed. Do you have any criminal convictions? £ Yes £ No

If you do not tick either the ‘Yes’ or ‘No’ box above, we will contact you to get this information and this will delay your enrolment. You must tick ‘Yes’ if you have a conviction unless it is a motoring offence that you received a fine or three penalty points for OR a spent sentence (as defined by the Rehabilitation of Offenders Act 1974). Please be aware that for certain courses, particularly in teaching, health, and social care, you must tell us about ANY criminal conviction(s), including spent sentences and cautions. If you are serving a prison sentence you must tick the ‘Yes’ box. If you are convicted of a criminal offence after you have enrolled, you MUST let us know immediately. If you are not sure whether to tell us about a previous conviction you should get more advice from your Citizens Advice Bureau or contact Advice and Admissions on 0800 612 6008

NATIONALITY

Please state your nationality

If you have dual or triple nationality, what are these?

In which country do you normally live?

Where have you lived for the past three years?

If you already have a visa, are there any restrictions on the length of your stay in the UK? £ Yes £ No

If ‘Yes’, please state your leave (Visa) type: Visa expiry date: DD / MM / YYYY

PLEASE NOTE: if you already hold a Tier 4 visa for another educational institution and you wish to study with us, you will need to submit a new visa application.

If you are applying for a visa to study in the UK, please complete Section 8. Otherwise please proceed directly to Section 9.

Section 8: International students only

8.a What type of visa are you applying for?

Tier 4 (adult): £ Short-term study visa (less than six months) £ Short-term study visa (up to 11 months) £

How many years have you been living in the UK? (if applicable) Have you ever studied in the UK before? £ Yes £ No

Date of entry into the UK: DD / MM / YYYY

8.b Your passport details Passport number (please attach a copy of your passport):

8.c Your level of English

If applying under the Tier 4 points-based system to join one of our International Foundation/Study or other further education programmes, you will need to pass a government approved secure English language test (SELT). Usually this would be academic IELTS for UKVI.

If applying under a Short-term study visa (up to six months) or Short-term study visa (up to 11 months) to join one of our English language or other short courses, you will need to show that you have enough English language knowledge to meet the level of the course. You will show this in a college assessment.

8.d Who will pay your fees?

Name: Relationship to you:

Address:

Main country of residence for the last three years:

8.e Checklist - please tick

£ Completed application form

£ Copy of passport

£ Copies of your exam certificates with certified translations

£ Portfolio if applying for art and design

£ Proof of your English language level

For further details on supporting documents you need, please email international@activatelearning.ac.uk

8.f Agent’s name if applicable

Agent’s name:

Agent’s contact details:

Section 9: Data protection

How we use your personal information – Privacy statement

The Activate Learning group collects, uses and retains certain types of personal data (as defined by the Data Protection Act 1998) in various formats about its students in order to carry out its functions as an education provider. By signing this application form you consent to the group processing your personal data as described in this statement. The group will use your personal data only for purposes associated with the administration and management of your education, unless otherwise agreed with you.

The personal information you provide is passed to the Skills Funding Agency and the Department for Business, Innovation and Skills (BIS). Where necessary it is also shared with the Department for Education, including the Education Funding Agency. The information is used for the exercise of functions of these government departments and to meet statutory responsibilities under the Apprenticeships, Skills, Children and Learning Act 2009 and to create and maintain a unique learner number (ULN) and a Personal Learning Record (PLR).

You will be contacted after you have completed your programme of learning to establish whether you have entered employment or gone onto further training. You may be contacted by the English European Social Fund (ESF) Managing Authority, or its agents, to carry out research and evaluation to inform the effectiveness of the study programme.

Further information about use of and access to your personal data and details of organisations with whom we regularly share data are available at: www.gov.uk/government/publications/sfa-privacy-notice

You have a responsibility to ensure that personal data provided to the group is accurate and up to date. Under the DPA (Data Protection Act) you are entitled to access your personal data held by the group (you will be charged a small administrative fee). If you wish to change the usage of your personal data by the group or have any queries relating to data protection, please contact Advice and Admission enquiries@activatelearning.ac.uk

Should you wish to opt-out of any of these in future you should put this in writing to the Group Data Manager, City of Oxford College, OX1 1SA

If you wish to receive details and advice on further study and career development opportunities from Activate Learning or career partners please tick this box £

If you wish you to receive details of other services the Activate Learning group provides please tick this box £

Activate Learning routinely contacts parents or carers of applicants under 18 about their application. If you are under 18 and do not wish your parent or carer to be contacted, please tick this box £

Declaration: I confirm that the information given on this form is correct to the best of my knowledge.

Check this box to confirm: £ Date of application: DD / MM / YYY

To submit this form please click ‘save’ below, then email the completed PDF to enquiries@activatelearning.ac.uk