Accrington Rossendale College Prospectus 2019-20

Disabilities and learning difficulties Do you have any medical conditions of which the College should be aware?

17+ Application Form For full-time courses starting in the academic year 2019/2020 only.

Yes

No

I prefer not to say

If Yes, please tick the appropriate box(es) below. Disability Visual Impairment

Hearing Impairment

Disability affecting mobility

Mental illness

How to apply - Return this completed for to: Central Admissions, Accrington and Rossendale College, Broad Oak Road, Accrington, Lancashire. BB5 2AW. When the college receives your completed application, you will be offered an interview where you can discuss your options with college staff. When you have been accepted and gained the necessary entrance qualifications, the next stage is enrolment which usually takes place at the end of August.

Other physical disability Other (please state below) ................................................................................................................................................................................................................................. Other medical conditions

Learning Difficulties Moderate learning difficulties

Severe learning difficulties

Dyslexia

Dyscalculia

Please use BLOCK CAPITALS.

Multiple learning difficulties Other (please state below) ................................................................................................................................................................................................................................. Course Details Which course or vocational area would you like to study?..................................................................................................................................... Exams Subject (Please list here the qualifications you have or are studying towards) Level Year Predicted / Actual grade Other specific learning difficulties

Personal details Gender: .............................................Title:....................................... National Insurance Number:....................................................................... Surname:.......................................................................................... First name: ................................................................................................. Middle name(s): .................................................................................................................................................................................................... Nationality:....................................................................................................................................... Date of birth:................................................ Contact details Address line 1: ...................................................................................................................................................................................................... ...........................................................................................................Town: ......................................................................................................... County:..............................................................................................Postcode:................................... Time at this address: ............................. Email address: ...................................................................................................................................................................................................... Telephone number:........................................................................... Mobile number: ......................................................................................... Have you been a resident in this country or the EU for the last three years? Yes No Emergency contact / Next of kin Name:.................................................................................................................................................................................................................... Emergency contact number: ............................................................Relationship: .............................................................................................. Ethnicity White Bangladeshi Pakistani Indian Chinese Black - Caribbean Black - African School Most recent school/college attended: .................................................................................................................................................................. How did you hear about the college? College Prospectus Young People’s Service Job Centre College Leaflet Word of Mouth Open Evening School Liaison Team Social Media Newspaper Other (please state) ..............................................................................................................................................................................................

Your application will not be progressed unless you agree to your data being recorded, processed and if appropriate for you to be contacted regarding the course you have applied for or other courses which may be appropriate for you.

Please tick to confirm your approval Preferred method of contact: Email Phone Post

If you do not wish your name and examination results to be published in the local papers, please tick this box

For school use only

Careers teacher’s signature endorsing the estimated grades, Signed: ........................................................................................................................................................Date: .................................................. Attendance on a scale of 1 to 4, with 1 as excellent and 4 as poor: 1 2 3 4 Please add any other comments which may be useful:........................................................................................................................................ ................................................................................................................................................................................................................................. School Liaison Officer:.....................................................................School Liaison’s Comment:.......................................................................... ................................................................................................................................................................................................................................ Date received:..................................................................................H.T. report requested: H.T report received: Interview by: .....................................................................................Interview recommendation: .......................................................................... ......................................................................................................................................................................................Transferred to Programme For college use only