Section 1: About yourself

First names: Family name:

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

Address line 1:

Address line 2:

Town/City:

County/State:

Postcode/Zip code: Country:

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

Email:

Regarding my application I would like to be contacted by: £ email only £ post only £ both

Emergency contact details (to be completed by all applicants). Please note this must be completed by a parent or carer if you are under 18.

Relationship to applicant:

First name: Last name:

£ Mr £ Mrs £ Miss £ Ms £ Other:

Address:

Primary phone number: Secondary phone number:

Email:

Section 2: Your course choice

Course code: Campus:

Course title:

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

In what year would you like to start your course?

If you would like an advice or guidance interview about choosing the right course please tick £

If you are applying for an apprenticeship please answer below.

£  I already have a job. Name of employer:

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

£  I need help finding a job What type of job:

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 Learner Services on 0800 371 434. Please note our website has accessibility functions, allowing you to adjust the size of the text and colour of the background.

Office useStudent ID no:

Section 3: Your previous education

If you are a current/previous student at the college please tick £

Name and address of secondary (senior) schools/colleges attended:

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: Extra support for you

The College welcomes and supports students with disabilities, medical conditions and language and learning support needs. This includes, and is not restricted to, support for mobility difficulties, visual impairments, deaf or hard of hearing, mental health difficulties, medical conditions such as epilepsy, and specific learning difficulties such as dyslexia.

Please describe here how we can support you at College (the information you supply here will be used to identify any support needs and will be kept confidentially):

If you would like a confidential interview to discuss access to support options, please tick £

If you would like to discuss any support you feel you need, please contact Bethan Webster on 0118 955 4583.

If you have any access requirements at interview, such as an interview room on the ground floor, a signer, or a hearing loop, please provide details.

How would you prefer to be contacted about additional support needs? £ Email £ Phone £ Post

Section 5: 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 Student Services on +44(0) 118 955 4300 or enquiries@reading-college.ac.uk

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

If you are applying for a visa to study in the UK, please complete Section 6. Otherwise please proceed directly to Section 7.

Section 6: International students only

6.a What type of visa are you applying for? Tier 4 (adult), Tier 4 (Child), Student visitor, Extended student visitor, Child visitor:

How many years have you been resident in the UK? (if applicable)

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

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

6.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) at a minimum B2 standard (equivalent to an IELTS score of 5.5). Our higher education and professional courses require a higher entry level (see our website for details).

If applying under the Tier 4 points-based system to join one of our English programmes you will need to pass a government approved secure English language test (SELT) at B1 standard (equivalent to an IELTS score of 4).

If applying under a Student Visitor or Extended Student Visitor visa to join one of our English language or other short courses, you will only need to show that you have enough English language knowledge to complete the course. You will show this in an online college assessment.

6.d Who will pay your fees?

Name: Relationship to you:

Address:

Main country of residence for the last three years:

6.e checklist - please tick

£ Completed application form

£ Copy of passport

£ Academic reference from your school or college

£ Copies of your exam certificates with translations

£ Portfolio if applying for art and design

£ Proof of your English language level

For further details on supporting documents you need, please visit www.activatelearning.ac.uk/international-AL

6.f Agent’s name if applicable

Agent’s name:

Agent’s contact details:

Section 7: Data protection

Information given on this form is personal data and is therefore subject to the UK Data Protection Act 1998. Information you provide on this form may be passed to relevant educational agencies and Adviza, which are registered under the Data Protection Act 1998. Further information about data confidentiality is available upon request from Learner Services.

The personal information you have provided may be passed to the Skills Funding Agency’s Learning Records Service (LRS) to create and maintain a Unique Learner Number (ULN).

The college or Adviza may contact you to provide details and advice on further study and career opportunities.

Please do not contact me about relevant courses and services at the college £Do not contact me by: £ post £ telephone £ email

We routinely contact parents or carers of applicants under 18 about their application.

I am under 18 and do not wish my parent or carer to be contacted about my application. £

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 complete PDf to enquiries@reading-college.ac.uk