uxbridge.pdf
2
1. Personal details Surname Mr Mrs Miss Ms First name/s Address Postcode Telephone Mobile Email Date of birth (dd/mm/yy) Age on 31 August (in the year that the course starts) If under 18 years, name of parent or guardian Parent or guardian contact telephone number: Home Mobile Country of birth 1.2 Have you been permanently resident in the UK/EU for the past three years? Yes (go to 1.3) No (go to 1.4) 1.3 Do you require a visa to study? Yes (go to 1.4) No (go to 2) 1.4 (i) Please give details of entry to the UK (ii) How were you admitted to the UK? (a) Student visa (b) Visitor (c) Refugee/asylum seeker (d) Other, please specify 2. Monitoring information (This is for statistical purposes only. Please indicate to which group you feel you belong.) Other, please specify 11 Bangladeshi 12 Indian 13 Pakistani 14 Asian Other 15 African 16 Caribbean 17 Black Other 18 Chinese 19 Mixed, White and Asian 20 Mixed, White and Black African 21 Mixed, White and Caribbean 22 Other Mixed Background 23 White British 24 White Irish 25 White Other Application form continues overleaf ➜ Application Form PLEASE COMPLETE IN BLOCK CAPITALS USING A BALLPOINT PEN Please return to: Admissions (Student Records), Uxbridge College, Park Road, Uxbridge, Middlesex, UB8 1NQ Reference No. (for office use only) 3. Course details I would like to be interviewed for admission to the following course: Course name Course code (must be completed)
Transcript of uxbridge.pdf
1. Personal details
Surname Mr Mrs Miss Ms
First name/s
Address
Postcode
Telephone Mobile
Date of birth (dd/mm/yy) Age on 31 August (in the year that the course starts)
If under 18 years, name of parent or guardian
Parent or guardian contact telephone number: Home Mobile
Country of birth
1.2 Have you been permanently resident in the UK/EU for the past three years? Yes (go to 1.3) No (go to 1.4)
1.3 Do you require a visa to study? Yes (go to 1.4) No (go to 2)
1.4 (i) Please give details of entry to the UK
(ii) How were you admitted to the UK? (a) Student visa (b) Visitor (c) Refugee/asylum seeker
(d) Other, please specify
2. Monitoring information(This is for statistical purposes only. Please indicate to which group you feel you belong.)
Other, please specify
11 Bangladeshi
12 Indian
13 Pakistani
14 Asian Other
15 African
16 Caribbean
17 Black Other
18 Chinese
19 Mixed, White and Asian
20 Mixed, White and Black African
21 Mixed, White and Caribbean
22 Other Mixed Background
23 White British
24 White Irish
25 White Other
Application form continues overleaf ➜
Application Form PLEASE COMPLETE IN BLOCK CAPITALS USING A BALLPOINT PEN
Please return to: Admissions (Student Records), Uxbridge College, Park Road, Uxbridge, Middlesex, UB8 1NQ
Reference No. (for office use only)
3. Course details
I would like to be interviewed for admission to the following course:
Course name Course code (must be completed)
6. Special requirementsDo you have a disability or learning difficulty? Yes No
If yes, please indicate what kind of disability or health issue you haveFor example:
Visual impairment Deaf Physical disability Dyslexia
Asperger’s/ASD Epilepsy Other, please specify
4. EducationAre you currently at school or college? Yes No
If yes, please give name of school or college and tutor
5. Other information(please give details of any employment, work experience, sports, interests or hobbies)
Signature of the applicant Date
Subject Level (e.g. GCSE) Date of exam Actual/predicted grade
4.1 Please list all the qualifications you already hold or are currently studying towards
Notice to applicantsUnder the terms of the Data Protection Act 1998, the personal information supplied by you will be treated in confidence, but may be used internally for other registered purposes and some of the information on this form will be sent to the Department for Education and funding agencies for statistical purposes.
I hereby declare that all the information above is correct and apply for admission to Uxbridge College.
If you would like to discuss your specific learning needs, please contact the Learning Support Team on 01895 853422.
Application Form continued
7. Please indicate how you heard about Uxbridge College:
Banner
Bus advert
Careers Event
Careers Officer/Connexions
Employer
Employment Service/Job Centre
Ex-student
Friend/relative (word of mouth)
Hotcourses website
Learndirect
Live in the area
Magazine advert
Newspaper
Open Day
Poster
Prospectus/leaflet
Relative
School
Shopping Centre
Student
Website
Other, please specify
We may use your details to contact you about College information, news and events. Please tick the box if you would prefer not to be contacted.
