Application Form Course Application FormCourse – 1st OptionMulti ConstructionMechanicsHair and BeautyCateringHealth and Social CareCourse – 2nd OptionMulti ConstructionMechanicsHair and BeautyCateringHealth and Social CareYour DetailsName First Last Email Date of Birth DD slash MM slash YYYY Perferred NameLegal SexPreferred Gender (if different)Your Contact DetailsAddress(Required) Street Address Address Line 2 City County Post Code Number(Required)Enter in your Mobile numberParent/Carer Details – Emergency Contact1st Emergency Contact (Parent/Carer) First Last Relationship to Student Address(Required) Street Address Address Line 2 City County Post Code Email 1st Emergency Contact's Number(Required) 2nd Emergency Contact (Optional)2nd Emergency Contact (Optional) First Last Relationship to StudentAddress Street Address Address Line 2 City County Post Code Email 2nd Emergency Contact's NumberNationalityWhat is your Nationality? British Citizen EU Citizen Other Nationality Country of Origin:Have you been living in the United Kingdom or European Union for the past 3 years? Yes No (If you are from outside the UK/Republic of Ireland) Have you been granted Refugee Status or Leave to Remain in the UK? Yes No Notes/Comments:Please note: You will need to bring your Passport or Birth Certificate to interview. Personal StatusAre you currently in care or a care leaver? Yes No Do you have any convictions which are not yet spent under the Rehabilitation of Offenders Act 1974 (as amended)? Please tick if you have any convictions which are not yet spent under the Rehabilitation of Offenders Act 1974. For further advice regarding unspent convictions contact NACRO at www.nacro.org.uk Yes No Do you have a Social Worker? Yes No Are you currently working with the Youth Justice Service (YJS – formerly YOT)? Yes No QualificationsWere you home educated? Yes No Where did you go to High School?Did you sit your GCSE exams?If yes, please state your achieved grades (or predicted grades if you are in Year 11) below. List(Required) Add RemoveSubject Grade/Predicted GradeHave you been to any other colleges since you finished school? Yes No If yes, where did you go?Did you complete your course at college? Yes No If yes, please state your achieved levels/grades below.(Required) Add RemoveSubject Level / GradeSupport NeedsDo you consider yourself to have any medical disability, learning difficulty or other health problem? Yes No Do you currently have an Education Health & Care Plan (EHCP)? Yes No We provide a range of support for students with disabilities and support needs. To ensure that we can provide you with any additional support you need during the application process, at interview and beyond, if you have a disability and/or support need, please tick the relevant boxes below as appropriate: Visual impairment Autistic spectrum condition Hearing impairment Multiple disabilities Disability affecting mobility Moderate learning difficulty Other medical condition e.g. epilepsy Dyslexia Speech and language difficulty Dyscalculia Mental Health Difficulty Multiple learning difficulty Social & Emotional Difficulties Other disability (Please specify) Other specific learning difficulty (Please Specify) Please select all the support needs relevant to you. (Please specify if ticked other)If you have ticked any of the above, we will discuss them further with you at interview.Do you have any allergies? Yes No If yes, please state your allergy:Why have you decided to apply to St-Eds? (Minimum 30 words)Why have you decided to apply for this particular course? (Minimum 50 words)Is there anything that would prevent you from attending every day, or prevent you from arriving on time every morning? Yes No If Yes, please state reasons below:If you have not achieved a 4-9 in your GCSE’s, what do you most want to improve with your English (Spelling/Punctuation etc.) and/or Maths?Declaration by ApplicantSt. Edmunds Society (in conjunction with East Coast College) has produced a Privacy Notice for students which is in accordance with the GDPR and the Data Protection Act 2018. The Privacy Notice is available on request from St. Edmunds Society. If you have any questions about this notice or the ways in which we use your personal information, please contact our Data Protection Officer at St. Edmunds Society, 113 – 118 Oak Street, Norwich NR3 3BP. Student Signature:I certify that all the information provided is correct. I agree that admission as a student is subject to my acceptance of the college’s regulations. Yes Date DD slash MM slash YYYY NumberNumberNumberSection Break
