Online Application

Please complete all details on this form. If you have any queries contact the Admissions Office

Personal Details

First name(s) (in full)
Surname
Gender
Date of birth	/ /
Permanent address
Postcode
Home telephone
Mobile telephone
Email address

Parent/Guardian

Name
Relationship to Student
Address (if different from student)
Daytime telephone
Evening telephone
Mobile telephone
Email address

Education

Name of most recently attended school/college
Name of Head/Principal
Date of leaving	/

Subjects studied or passed

Type of examination (GCSE, AS, or exams taken at 16 in your home country):

Subject	Result/Predicted Grade	Year

Possible course choices

Please consult our Prospectus for course information.

Course choice	Level

Further Information

Include information about school activities and other outside interests including part-time jobs and a possible career: (maximum of 3000 characters)

Do any of the following apply to you?

This confidential information is needed to help the college give you the support you need.
Please tick which answer applies to you:

A health condition (such as diabetes, epilepsy, heart or any other serious condition)?
Physical or sensory disability?
Learning needs (such as dyslexia, need for extra English or Mathematics support)?

We have developed courses and support which enable students to integrate well and fulfil their potential, and are committed to ensuring that people with disabilities, including those with learning difficulties, are treated fairly. All reasonable adjustments to provision will be made to ensure that students and others are not substantially disadvantaged. We welcome the opportunity to discuss how we can be of help to those requiring learning support – please contact Anne Cook, in the Study Development Centre, in the first instance.

Ethnic Group

The Department of Education has requested that colleges collect this information in order to promote educational and training opportunities for all. It will be treated in the strictest of confidence.

Residency

Please indicate your main residency for the last 3 years preceding the year ending 30th June 2013:

Data Protection Act 1998

Information supplied on this form will be used by the Principal and staff for the management of the college. It will also be passed to the Learning and Skills Council (The Council) which is registered under the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data.

Confirmation

I confirm that the information I have given on this form is accurate and I agree to the transfer of my information from my feeder school to Itchen Sixth Form College.