Sitemap
header
Home
The College
About Us
The Campus
Did We Get it Right?
College Awards
Former Students
What role does accross play in the economy?
Publications Scheme
Equality and Diversity Statement
Meet Our Students
College Calendar 2010-11
Greening The College
Useful Links
Campus Highlights
Information +
Library +
The College Shop
Learner Support
Traders Brasserie
Seasons Salon
Coppice Theatre
Innovation Centre
Governance
Job Vacancies
Courses
14-19
Adult Learning
Apprenticeships
Higher Education
Business Solutions & Train to Gain
Multimedia
Photo Gallery
Publications
Videos & Radio
Apply & Enrol
Contact Us
Course Application Form
Please complete this form giving as much detail as possible. Fields with an * are compulsory and must be completed.
Personal Details
Left col
Title:
select...
Mr
Mrs
Miss
Ms
Surname:
*
First Name:
*
Middle Name:
*
National Insurance Number:
Right col
Sex:
*
select...
Male
Female
Nationality:
*
select...
UK
EU
Other
Date of Birth:
*
(dd/mm/yyyy)
Course Details
Which course or vocational area would you like to study?:
*
School
Most recent School/college attended:
*
Where did you hear about the college?:
select...
College FE Prospectus
College HE Prospectus
College Leaflet
College People Paper
Connexions
Job Centre
Local College (nearest)
Mail Shot
Newspaper Accrington Observer
Newspaper Clitheroe Advertiser
Newspaper Lancs. Evening Telegraph
Newspaper Lancashire Family Magazine
Newspaper Rossendale Free Press
Newspaper/magazine other
Open Evening
Other
Postcard
Radio / TV
Referral from other organisation
Schools Liaison
Studied here before
Website of another organisation
Word of Mouth
Have you attended a school-partnership programme at this college?:
Yes
No
If Yes, what course?:
Exams
Please list any exams you are taking or you have already taken:
Subject:
Level:
Year (e.g 2004):
Predicted/Actual Grade:
Subject 1:
Level 1:
Year (e.g 2004) 1:
Predicted/Actual Grade 1:
Subject 2:
Level 2:
Year (e.g 2004) 2:
Predicted/Actual Grade 2:
Subject 3:
Level 3:
Year (e.g 2004) 3:
Predicted/Actual Grade 3:
Subject 4:
Level 4:
Year (e.g 2004) 4:
Predicted/Actual Grade 4:
Subject 5:
Level 5:
Year (e.g 2004) 5:
Predicted/Actual Grade 5:
Subject 6:
Level 6:
Year (e.g 2004) 6:
Predicted/Actual Grade 6:
Subject 7:
Level 7:
Year (e.g 2004) 7:
Predicted/Actual Grade 7:
Subject 8:
Level 8:
Year (e.g 2004) 8:
Predicted/Actual Grade 8:
Subject 9:
Level 9:
Year (e.g 2004) 9:
Predicted/Actual Grade 9:
Contact Details
Contact left col
Address Line 1:
*
Address Line 2:
County:
*
Country:
*
Postcode:
*
Contact right col
Time at this address?:
Telephone Number:
*
Mobile Number:
*
Email Address:
*
Have you been resident in this country or the EU for the last three years?:
*
select...
Yes
No
Emergency Contact / Next of Kin
Name:
Relationship:
select...
Parent
Guardian
Spouse
Partner
Son/Daughter
Statistical
Ethnic Group?:
select...
Bangladeshi
Black African
Black Caribbean
Black Other
Chinese
Indian
Pakistani
White
Other Asian
Other
Not Known
Learning Difficulties/Disabilities
Do you have any medical conditions of which the College should be aware?:
I consider myself to have a learning difficulty and/or disability
I do not consider myself to have a learning difficulty and/or disability
I prefer not to say
Disabilities:
select...
No Known Disabilities
Visual Impairment
Hearing Impairment
Disability affecting mobility
Other physical disability
Other Medical condition (eg epilepsy asthma diabetes)
Emotional / behavioural difficulties
Mental Ill health
Temporary disability after Illness (eg post viral or accident)
Profound / complex disabilities
Multiple disabilities
Other
No disability
Not known/information not provided
Learning Difficulties:
select...
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Other specific learning difficulty
Multiple learning difficulties
other
No learning difficulty
Not known / information not provided
Confidentiality
Confidentiality:
I agree to the College using my contact details to inform me of future study opportunities at Accrington and Rossendale College.
Data Protection Act 1998
The information you provide on this form will be passed to the Learning and Skills Council. The Learning and Skills Council is registered under the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data. The Learning and Skills Council 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.
CAPTCHA
Please complete this challenge to prove that you are not a robot.
What code is in the image?:
*
Copy the characters (respecting upper/lower case) from the image.
