Personal Details
It is important we have the right details for you so we can provide you with the best experience
Name
*
First Name
Last Name
Date of birth
*
-
Day
-
Month
Year
Date
Census Date
-
Day
-
Month
Year
Date
Todays Date
-
Day
-
Month
Year
Date
Number
Legal Gender
*
Male
Female
National Insurance Number
Have you ever be known by another name?
First Name
Last Name
Have you studied with the College before?
*
Yes
No
Address
*
Street Address
Street Address Line 2
Town
County
Postcode
Telephone Number
-
Area Code
Phone Number
Mobile Phone Number
*
Email
*
Confirmation Email
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
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Parent / Guardian Contact Details
Parent / Guardian Name
First Name
Last Name
Parent / Guardian Address (If different to your home address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent / Guardian Phone Number
Parent / Guardian email
example@example.com
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Residency
How long have you live in the UK?
*
From Birth
Other
If other, how many years have you lived in the UK?
Have you been a full, legal UK resident for the past 3 years for any purpose other than study?
*
Yes
No
If No, please tell us the date you entered the UK
-
Month
-
Day
Year
Date
Do you hold a tier 4 VIsa?
Yes
No
Do you have any of the following Immigration status (evidence required)?
Asylum Seeker
Refugee Status
Stateless Person Status
Discretionary Leave to Remain
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Equality and Diversity
Which of the following best describes your background?
*
31 - English/Welsh/Scottish/Northern Irish/British
32 - Irish
33 - Gypsy or Irish Traveller
34 - Any other White background
35 - White and Black Caribbean
36 - White and Black African
37 - White and Asian
38 - Any other Mixed/Multiple Ethnicity
39 - Indian
40 - Pakistani
41 - Bangladeshi
42 - Chinese
43 - Any other Asian background
44 - African
45 - Caribbean
46 - Other Black/African/Caribbean
47 - Arab
98 - Any other Ethnic background
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Previous Education
Have you recently left school / full time education?
*
Yes
No
What is the last school or college you attended?
I am NOT enrolled with another school, college or training provider for the 2020/21 Academic year
Yes
Do you have GCSE English?
Yes
No
What is the highest grade you have achieved in GCSE English?
U
1
2
3
4
5
6
7
8
9
G
F
E
D
C
B
A
A*
Did you Achieve this before the end of Year 11?
Yes
No
Do you have GCSE Maths?
Yes
No
What is the highest grade you have achieved in GCSE Maths?
U
1
2
3
4
5
6
7
8
9
G
F
E
D
C
B
A
A*
Did you Achieve this before the end of Year 11?
Yes
NO
What is the highest level of qualification you have achieved?
Entry Level
Level 1
Full Level 2(e.g 5 GCSEs A*-C)
Full Level 3(e.g 3 A-Levels A*-C)
Level 4
Level 5
Level 6
Level 7
Bachelors Degree
Masters Degree
PhD
None
Other
None
If Other, please specify
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Prior Qualifications
Please tell us about the qualifications you already have, if you are waiting for results please tell us your predicted grade.
Tell us about your qualifications
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Learner Support
We are committed to providing you with the best support we can during your time at the College
What statement best describes you?
I consider myself to have a learning difficulty or disability
I do not consider myself to have a learning difficulty or disability
Which learning difficulty or disability? Please select all that apply to you
Visual Impairment
Hearing Impairment
Disability affecting mobility
Profound complex disability
Social & emotional difficulties
Mental health difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia, Dyscalculia
Autism Spectrum disorder
Asperger's syndrome
Temporary disability after illness or accident
Speech, language and communication needs
Other physical disability
Other specific learning difficulty
Other medical condition (e.g. epilepsy, asthma, diabetes)
Other learning difficulty, Other disability
Hold the Ctrl key to select multiple if your using a desktop or laptop
Which do you consider to be your primary learning difficulty or disability?
Visual Impairment
Hearing Impairment
Disability affecting mobility
Profound complex disability
Social & emotional difficulties
Mental health difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia, Dyscalculia
Autism Spectrum disorder
Asperger's syndrome
Temporary disability after illness or accident
Speech, language and communication needs
Other physical disability
Other specific learning difficulty
Other medical condition (e.g. epilepsy, asthma, diabetes)
Other learning difficulty, Other disability
Are you currently in care?
*
Yes
No
Are you a care leaver?
*
Yes
No
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Criminal Convictions
Are you currently, or have you ever been the subject of any investigations or inquiry by the police, a statutory agency or any other body, into abuse or neglect of a child or vulnerable adult or other inappropriate behaviour?
*
Yes
No
Do you have any convictions, cautions, reprimands or final warnings that are not protected as defined in the Rehabilitation of Offenders Act 1974?
*
Yes
No
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Employment Status
What is your current employment Status?
I am in paid employment
I am Self-Employed
I am unemployed, looking for work and available to start work
I am unemployed, NOT looking for work and NOT available to start work
How long have you been unemployed for?
0-3 months
4-6 months
7-12 months
12 months or more
How long have you been in your current job?
0-3 months
4-6 months
7-12 months
12 months or more
How many hours a week do you normally work?
0-10 hours
11-20 hours
21-30 hours
More than 30 hours
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Employers Details
Tell us about your current employer, you can skip this section if you don't wish to disclose this information
Employers Name
Employers Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Employers Phone Number
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Declarations
Funding may be available for your course, in order to help us make the right decision please read these statements carefully and select yes if they apply as they may help secure funding.
Are you unemployed or in receipt of Universal Credit, actively seeking work, in receipt of an active state benefit in you name, earning less than £338 per month for sole adult claims or £541 per month for join benefit claims with your partner?
Yes
No
Are you employed, eligible for co-funding, with a gross annual salary below £18,135 but cannot contribute towards the cost of co-funding fees?
Yes
No
Do you have a full level 2 qualification?
Yes
No
Do you have a full level 3 qualification?
Yes
No
If you are currently in receipt of benefits, please indicate which ones?
Job seekers allowance
Universal Credit
Employment Support Allowance (ESA or WRAG)
Incapacity Benefit
Disability Living Allowance
Council Tax Reduction (Excluding single person discount)
Housing Benefit
Carer's Allowance
Income Support
Industrial Injuries Disablement Benefit
Disability Premium
Pernsion Credit / Child Tax Credit
Employment Support Allowance (Non WRAG)
Working Tax Credits
Other benefit not listed
I am not in receipt of any benefits
Please select the statement that best reflects your personal circumstances
*
No household member is in employment and the household includes one or more dependent children
No household memebr is in employment and the household does not include any dependant children
I live in a single adult household with dependent children
None of the above.
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Privacy Notices
The College is funded by the Education and Skills Funding Agency (ESFA) and the West Midlands Combined Authority (WMCA). Please click on the links to view the ESFA & WMCA privacy policies
You can agree to be contacted by the funding agency (ESFA) for other purposes by selecting which methods you would like to be contacted by. Select all that apply
About courses and learning opportunities
For Surveys and Research Purposes
By Post
By Email
By Phone
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Data Protection and Declaration
Your privacy is important to us, please read this section carefully.
Please select all that apply
I consent to the college providing employment and/or character references in the future based on this registration and my time at the college
I consent to the college informing me of progression opportunities after I have left the college
I consent to the college using my image in publicity materials
Signature
I confirm that the information provided in this document is true to the best of my knowledge and understand that any false information may result in additional fees or withdrawal from the college with immediate effect .
*
Clear
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Upload a photo for your ID card
Please upload a passport style photo without hats or hoods for your college ID card, if you're using a mobile device you can take a selfie. Make sure you have a plain background and your face is clearly visible. If you are on a PC or laptop and don't have a photo don't worry. You can skip this for now and take a photo in the college
Upload photo
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Proof of Identity
Please upload your proof of identity. This could be a copy of your birth certificate, passport, driving licence, national identity card. If you don't have this available right now you can skip this step and bring it with you when you come to college.
Upload proof of ID
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What technology do you have regular access to at home? Select all that apply
Desktop PC / Laptop
Broadband Internet
Mobile Phone / Tablet
None
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