APPLICATION FORM 2010/2011
Please return completed application and reference form to:
Student Number: Unique Learner Number:
Please complete only the BORDERED WHITE BOXES of the form in BLOCK CAPITALS and in ink Office Course Information Centre, Westminster Kingsway College, St Jamess Park Centre, Castle Lane, London SW1E 6DR use only
Section 1: Your personal details.
Mr / Mrs / Miss / Ms / Other
Please enter your name as it appears on official documents: Title: Male Female AG
Family name / Surname First name(s) Date of birth Parental home
D D M M Y Y Y Y
Age on 31st August 2010
Please enter your address including postcode (please remember to let us know if you move house after applying): Own home Other: Please state
Postcode Home contact no Email address Mobile no
Section 2: The course(s) you are applying for.
Please state which course(s) you are applying for. Please list all subjects individually. Course/Subject and Level - if AS/A2 please list up to 4 subjects/levels chosen First choice: Second choice No I would like to have a general guidance interview to look at all of my options: Yes Applicants aged 16-18: please remember that the reference form on page 4 must be completed by your school or college before your application can be considered. Centre
Section 3: Additional support.
The college provides a wide range of additional support. Please let us know if you have a disability such as a hearing or visual impairment, a mental health difficulty or a mobility difficulty. Please also let us know if you have dyslexia or a learning difficulty. This will not affect your application but is to enable us to consider your additional support needs. I have a disability and may need support at interview or on course. Yes No I have dyslexia or a learning difficulty and may need support on course. Yes No SUP
Section 4: Equal opportunities.
Completing this section will help us to monitor the services that we are offering as we aim to promote equal opportunities. Please tick the box that is closest to how you describe your ethnicity. Information will not be used in selecting students for courses. 11 23 Asian or Asian British - Bangladeshi 17 Black or Black British - any other White - British 12 24 Asian or Asian British - Indian Black background White - Irish 18 13 25 Asian or Asian British - Pakistani Chinese White - Any other White back14 19 Asian or Asian British - any other Mixed White and Asian ground 20 98 Asian background Mixed White and Black African Any other 15 21 Black or Black British - African Mixed White and Black Caribbean 99 Not known/information not 16 22 Black or Black British - Caribbean Mixed - Any other Mixed backprovided ground What is your nationality? What language(s) do you speak at home? What is your country of birth? Page 1
Section 5: Residency.
Have you lived in the UK all of your life? Yes No If No, when did you come to the UK? (month/year) M How long did you live there? When does it expire? M
M Y Y M Y Y
In which country did you live before entering the UK? Do you have a visa? Yes No If yes, what type?
years
Section 6: Education and qualifications.
Name and address of the school or college you are/were attending in 2009/2010. QUL If you have already left school or college, please write the name of the last school/college you attended and when you left.
Date ended M M Y Y Please list any qualifications you have, or expect to obtain before you start your course. If English is not your first language, you must indicate which English language exams you have taken and passed. CRS Subject Level Exam board Date of exam
M M M M M M M M M M M M M M M M M M M M Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Predicted grade
Actual grade
All International students should enclose certified copies of their certificates/qualifications with their application.
Section 7: Tell us about yourself.
Remember to tell us why do you want to do this course, what skills and experience you have that may be useful when studying this course? (E.g. part-time work, voluntary work, other courses you have taken in a similar subject.) What do you plan to do after you finish this course? What are your career plans?
Page 2
Section 8: Employment details (if your course requires work-based experience).
Company name and address Postcode
Section 9: How you heard about Westminster Kingsway College (WKC).
In order that we might target our publicity more effectively, we would be grateful if you would tell us how you heard about Westminster Kingsway College - please tick all that apply. Sources HotCourses Floodlight WKC website Facebook MySpace Internet, Emails, Choices London Text messages etc Choice FM YouTube WKC email Blyk text Other website - please state below Choice FM Other newsletter Newsletters WKC LBC Heart Radio, TV Choice FM HotCourses Floodlight WKC Prospectuses, Printed media Newspaper/magazine ad Please name: below Your college Connexions Your school Jobcentre Plus Employer Advice providers School open day SkillsLondon other advice provider Friend Neighbour Family member Word of mouth Other - please state below Other Please state, if not shown above Source type LearnDirect Bebo WKC text - please state below Trouble TV LondonColleges Twitter Blyk email
WKC Advisors Library Current student
Careers fair LearnDirect Past student
Section 10: Criminal Convictions.
Do you have any unspent criminal convictions? Yes No CC You do not have to tell us about any convictions that are spent (as defined by the Rehabilitation of Offenders Act 1974) , or about any cautions, reprimands or final warnings. You must disclose all unspent convictions of any offence. For further advice about whether convictions are unspent please contact the NACRO Helpline on 0800 0181 259. Do you have any relevant criminal convictions(see below)? Yes No
Relevant means offences against a person, whether of a violent or sexual nature and convictions involving unlawful supplying of or possession of controlled drugs or substances. Declaring a conviction will not necessarily prevent you from being offered a place at College but failure to disclose something which we later become aware of could result in disciplinary action. Please note that some of our courses, such as care, childcare or health studies, require you to disclose spent and unspent convictions, as well as cautions, reprimands and final warnings in the context of legislation on safeguarding children and vulnerable adults.
Section 11: Declaration and signature.
Data Protection Act 1998
The information you provide on this form will be passed to the Learning and Skills Council (LSC). The LSC is registered under DEC the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data. The LSC will collect and share this information with other organisations for the purpose of administration, careers and other guidance, statistical and research purposes. This will enable the Council and its partners to monitor performance, improve quality and plan future provision. If you are under 19 years some information may be passed to Connexions. All data is stored and processed in accordance with the Data Protection Act.
I do not wish the LSC or its partners to contact me about my learning experience. contacted.) (Please tick here if you do not wish to be
Signature of applicant:
Date:
PLEASE NOTE: We require a reference for any applicant aged 16-18.
Please send this completed application form to your school or other appropriate referee (not friend or family). Your application will not be considered until the reference form on page 4 has been completed CIFA inits__________Date scrn__________ Page 3 REF
Reference Form 2010-2011
Please tick the suitability of the applicant to undertake the course shown.
Suitability for the programme
Excellent Good
Attendance Punctuality Behaviour Motivation Oral communication Written communication Quality of work Academic ability Ability to work on own initiative Attitude to School/College/work environment Relationships with peer groups and teachers Ability to work as a member of a team Has the applicant ever been excluded or suspended? Yes o No o
Referees details:
Average Unsatisfactory
Name:
Poor
Position:
Organisation:
Relationship to applicant:
Address including post code:
Telephone:
E-mail address:
Please complete all the sections that are relevant to your knowledge of the applicant.
Subjects
Level Grade Actual Predicted
Please indicate in the appropriate box the actual or predicted grade
Please use this space to make any comments.
Additional learning needs
Signed: Date: Organisations official stamp:
Does this applicant require...?
a) ESOL support
Yes o No o Comments
b) Dyslexia support
Yes o No o Comments
c) Other learning support
Yes o No o Comments
Please return completed application form and reference form to:
d) Particular pastoral support Yes o No o Comments
e) Disability support
Yes o No o Comments
Course Information Centre Westminster Kingsway College, St Jamess Park Centre, Castle Lane, London SW1E 6DR
