Documente Academic
Documente Profesional
Documente Cultură
1. Personal details
Surname
Mr
Mrs
Miss
Ms
First name/s
Address
Postcode
Telephone
Mobile
Email
Date of birth
(dd/mm/yy)
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)
Yes
(go to 1.4)
No
(go to 2)
(b) Visitor
15 African
23 White British
12 Indian
16 Caribbean
24 White Irish
13 Pakistani
17 Black Other
25 White Other
14 Asian Other
18 Chinese
3. Course details
I would like to be interviewed for admission to the following course:
Course name
Course code
(must be completed)
4. Education
Are you currently at school or college?
Yes
No
4.1 Please list all the qualifications you already hold or are currently studying towards
Subject
Date of exam
Actual/predicted grade
5. Other information
(please give details of any employment, work experience, sports, interests or hobbies)
6. Special requirements
Do you have a disability or learning difficulty?
Yes
No
If yes, please indicate what kind of disability or health issue you have
For example:
Visual impairment
Deaf
Physical disability
Aspergers/ASD
Epilepsy
Dyslexia
If you would like to discuss your specific learning needs, please contact the Learning Support Team on 01895 853422.
7. Please indicate how you heard about Uxbridge College:
Banner
Employer
Hotcourses website
Open Day
Shopping Centre
Bus advert
Learndirect
Poster
Student
Careers Event
Ex-student
Prospectus/leaflet
Website
Careers Officer/Connexions
Magazine advert
Relative
Newspaper
School
Notice to applicants
Under 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.
Date
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.