Application Form

Personal Details

Title *

First Name *

Last Name *

Gender *

Date of Birth *

Nationality *

Have you been a permanent resident of the UK for the last three years? *
YesNo

If no please state the date of first entry to live in the UK

Do you have a disability, medical condition or learning difficulty? *

If yes please state disability

If other please state

If yes please state learning difficulty

If other please state

Would you require any special arrangements for the interview?

If yes please state

Have you ever been convicted of a criminal offence (not including motoring offences) or have any ongoing?*

Which school have you attended in the past 3 years? *

If other please state

Contact Details

Enter postcode*

Address 1*

Address 2

Town/City*

County

Email*

Home Telephone (Please provide at least one contact number)

Day Time Telephone

Mobile Number

Parent/Guardian Details

Parent/Guardian Name*

Enter Parent/Guardian postcode*

Parent/Guardian Address 1*

Parent/Guardian Address 2

Parent/Guardian Town/City*

Parent/Guardian County

Parent/Guardian Email*

Parent/Guardian Telephone*

Qualifications

Please fill in each section below

Please select which best describes the highest qualifications you are predicted to achieve, or have already achieved

Predicted or Achieved?

Please select which best describes the highest English qualifications you are predicted to achieve, or have already

Predicted or Achieved?

Please select which best describes the highest Maths qualifications you are predicted to achieve, or have already

Predicted or Achieved?

Course Details

Please select up to two courses you are applying for

Course 1*

Course 2

DATA PROTECTION

Coulsdon Sixth Form College and Croydon College will use the personal data you have included on this form for the purpose of processing your application and for planning purposes. We will do that on the basis of the contractual arrangement with the College which you are applying for. We will retain your personal data for as long as is required for that purpose.

We may share your data with government departments and agencies, to the extent required and permitted by law. There is further information on the web site at https://www.croydon.ac.uk/docs/default-source/default-document-library/privacy-notice.pdf about your rights, how Croydon College protects your privacy and how to contact the Data Protection Officer if you have any concerns.

HOW DID YOU HEAR ABOUT US?
Please select how you heard about Coulsdon Sixth Form College

DECLARATION

You must select the below box to proceed.

I confirm the information given is correct

Personal Details

Contact Details

Parent/Guardian Details

Qualifications

Course Details

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