Skills For Independence

Personal Details

Title*

First names*

Last name*

Gender*

Male
Female

Date of birth*

Age on 31/08/2020 - 16 to 18 or up to 25 years old with a EHCP*

House Number and Street Name*

City*

Postcode*

Telephone Number*

Mobile Number

Email Address*

NI No*

Nationality*

Next of kin name*

Relationship to you*

Next of kin contact number*

Ethnicity

We are committed to equal opportunities. To help us monitor our policy please complete the following

Untitled*

Have you lived outside the UK during the last 3 years?*

Yes
No

Date of entry into the UK*

Are you legally allowed to stay in the UK?*

Yes
No

Are you seeking asylum?*

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No

Programme you're applying for

1st Choice*

2nd Choice*

Most recent Secondary School/College

Date attended from*

Date attended till*

Please rate your attendance*

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Qualifications

Please list any qualification for which you are studying (starting with Maths and English) and predicted grades

List*

Qualifications achieved	Grade	Date achieved (Month / Year)

List*

Qualifications currently studying	Predicted Grade	Completion date (Month / Year)

Additional Support

We want you to get the best from your time at College and can offer a range of support measures to help you successfully complete your course (please ask if you would like further details). Please let us know if you have any learning support needs, disabilities or medical conditions for example wheelchair user, mental health challenges, epilepsy, dyslexia, hearing or visual impairment.

Do you have a learning difficulty, disability or health need which may affect your ability to study?*

Yes
No

If yes please state*

Did you receive additional support in school or in your previous college?*

Yes
No

If yes please state*

Do you have an Education Health Care Plan (EHC)?*

Yes
No

You can agree to be contacted for other purposes by ticking any of the following boxes

About courses of learning opportunities
For surveys and research

Method of contact

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How did you hear about the course?*

Declaration: I understand that the information provided on this form may be used for any matter relating to my application and for statistical and research purposes by the College or organisations commissioned by the College. Information provided on ethnic origin is for statistical purposes only and will be treated as strictly confidential. The Funding Authority / City College Peterborough may wish to contact you in the future. If you give permission to be contacted, please tick the appropriate boxes.

If you give permission to be contacted, please tick the appropriate boxes.*

I give permission to be contacted by the Funding Authority
I give permission to be contacted for market research purposes
I give permission to be contacted by the College / Funding Authority in relation to courses, events or other services.

Final confirmation*

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Comments

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16-19 > Courses

Study Programme

Courses for Learners with Learning Difficulties and Disabilities – Skills for Independence

Personal Details

Ethnicity

Programme you're applying for

Qualifications

Additional Support

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16-19 > Courses

Skills for Independence

Study Programme

Courses for Learners with Learning Difficulties and Disabilities – Skills for Independence

Personal Details

Ethnicity

Programme you're applying for

Qualifications

Additional Support

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