2023-2024 Student Application Form

Personal Details

Title Mr Mrs Ms Miss Other

Family Name
If you have answered NO to the above questions we will discuss this with you in your advisory interview.

Given Name(s)

Preferred Name(s)

Mobile

Email

Date of Birth
Age on 1st September 2023

Gender (please check)

MALE

FEMALE

Living Arrangements

Do you live at the parental home? (please check)
YES NO

Address

Town

County

Postcode

Home Telephone

You must inform the college if your personal information changes

Emergency Contacts

Should an emergency occur at college, it may be necessary to contact someone urgently. Please supply some emergency contacts (e.g. parent's / relative's work telephone number).

Parent's / Guardian's Name (please check as appropriate)

Mr Mrs Ms Miss

Family Name

Relationship to Student

Address

Town

County

Postcode

Mobile

Home Telephone

Email

Second Emergency Contact (please check as appropriate)

Mr Mrs Ms Miss

Relationship to Student

Address

Town

County

Postcode

Mobile

Home Telephone

Email

Student ID
Ignore if not known

Unique Learner Number.
Ignore if not known

National Insurance Number
Ignore if not known

Name of Present or Last School / College with Leaving Date

School Name

Address

Date of Leaving (dd/mm/yyyy)

Learning Difficulty/Disability/Health Information (please check)
Do you consider yourself to have a learning difficulty or disability? YES NO
4 Visual impairment	15 Asperger’s syndrome
5 Hearing impairment	16 Temporary disability after illness or accident
6 Disability affecting mobility	17 Speech Language and Communication needs
7 Profound complex disabilities	93 Other physical disability
8 Social and emotional difficulties	94 Other specific learning difficulty
9 Mental health difficulty	95 Other medical condition
10 Moderate learning difficulty	96 Other learning difficulty
11 Severe learning difficulty	97 Other disability
12 Dyslexia	13 Dyscalculia
14 Autism spectrum disorder	Prefer not to say
If other please state
Do you have an EHCP? YES NO

Ethnicity (please check)
White
31 English/Welsh/Scottish/Northern Irish/ British	33 Gypsy or Irish Traveller
32 Irish	34 Any Other White Background
Mixed/Multiple Ethnic Groups
35 White and Black Caribbean	37 White and Asian
36 White and Black African	38 Any Other Mixed/Multiple Ethnic Background
Asian/Asian British
39 Indian	42 Chinese
40 Pakistani	43 Any other Asian Background
41 Bangladeshi
Black/African/Caribbean/ Black British
44 African	46 Any other Black/African/Caribbean Background
45 Caribbean
Any Other Ethnic Group
47 Arab	98 Any Other Ethnic Group

Eligibility for Study/Funding (Fee Remission)

Have you been a resident in the UK for the past three years? (please check) i.e since August 2020 * YES NO
If you have answered NO to the above question we will request additional documentation from you.

Date of Entry to UK (dd/mm/yyyy)

Nationality*

Is English your second language? (please tick) YES NO

Examinations Taken or to be Taken
Examinations Subject(s)	Level e.g. GCSE, BTEC	Month/Year Taken, To Be Taken	Mock/Forecast Result	Actual Result Where Known
English Language
English Literature
Mathematics

Why do you want to come to college?

List below your interests and activities

Please list any relevant work experience

Careers which Interest You

Current part-time or full-time employment

Please list the Examination Courses (subjects and levels)	you are interested in taking at College (to be discussed at advisory interview)
Type of course (e.g.A level, Level 3, Level 2, Level 1, GCSE and HND)	Subject(s)

Criminal Convictions

Do you have any criminal convictions? (please tick) YES NO

Data Protection Act - GDPR

Bexhill College and the Education and Skills Funding Agency (ESFA) comply with the Data Protection Act 1998 and the General Data Protection Regulation 2018. By providing the information you have on this application form, you consent to Bexhill College holding and processing the information in accordance with data protection legislation. The information on this form will be passed to the ESFA to meet our legal responsibilities under the Apprenticeships, Skills, Children and Learning Act 2009 and for the Agency's Learning records service to create or verify your Unique Learner Number (ULN).

I declare that, to the best of my knowledge, the information I have given is a true and correct record and I give my consent to Bexhill College processing and use of such data for any purpose connected with my studies, my health and safety or other legitimate reason.

I have read and understood the Student Privacy Notice and General Privacy Notice on the website.

If you do not agree we cannot process your application.

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