My Application

Background

Address*

Address Line 1 Address Line 2 Town/City County Postcode Country

Other information

National insurance number

Unique Learner Number (if known)

Nationality*

Do you consider English to be your first language?*

Yes
No

What do you consider to be your first language?

Residency

Have you been a permanent resident in the UK/EU/EEA for the past 3 years?*

Yes
No

If no, please state the country you have been living in

Date of entry to the UK/EU/EEA

Do you need a visa or permission to live in the UK?*

Yes
No

Are you:

An asylum seeker legally in the UK for 6 months or more pending consideration of a claim by the Home Office
An asylum seeker refused asylum but eligible for support under Section 4 of the Immigration and Asylum Act
A refugee or spouse/child of a refugee
An international student
Married to or in a recognised civil partnership with a person (with settled status) for a year or more

Please state the date of your marriage or civil partnership

Do you have:

A Home Office or solicitor’s letter, or an Application Registration Card
Fixed leave to remain
Indefinite leave to remain
A student visa

What is the expiry date of your student visa?

Ethnic origin

Which of the following best describes your ethnic origin?*

Emergency contact

Who should we contact in case of an emergency?

First name*

Last name*

Relationship to you*

Home telephone

Mobile telephone*

Parent/Guardian/Carer

Please complete if you are aged under 19.

First name

Last name

Relationship to you

Address

Address Line 1 Address Line 2 Town/City County Postcode Country

Home telephone

Mobile telephone

Email

Disclosing criminal convictions

Do you have a criminal conviction?*

Yes
No

Do you have any criminal allegations pending?*

Yes
No

If you have answered yes to either of these questions, a Criminal Conviction Declaration form will be sent to you shortly. Please complete and return this form as soon as possible. Your application will not be processed until this has been received.

Qualification	Subject	Place of study	Grade	Year achieved

Personal details

Background

Other information

Residency

Ethnic origin

Emergency contact

Parent/Guardian/Carer

Disclosing criminal convictions

References

Employer or character reference (cannot be related to you)

School/college reference

Work placement

Support/Needs

Supporting your learning

Equal opportunities monitoring

Care leavers, Looked After Children and young carers

Statement of education

If you attended school within the past five years, please provide details here:

If you attended college/university, please provide details here:

If you have taken a GCSE in English and/or Maths please provide details of the grade(s) you achieved below. If you have not achieved a GCSE in English or Maths, please enter ‘None’ in the grade boxes below:

Other qualifications

Confirmation

Payment