Course Application

TITLE (*)

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LAST NAME (*)

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FIRST NAME(S) (*)

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DATE OF BIRTH (dd/mm/yyyy) (*)

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AGE

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GENDER (*)
Male
Female

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ADDRESS (house number / street / town (*)

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POSTCODE (*)

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HOME TEL NO

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MOBILE TEL NO

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EMAIL ADDRESS (*)

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CHOICE OF COURSE (*)

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MODE OF STUDY (*)
Full-time
Part-time day
Evening

Select mode of study
HOW DID YOU HEAR ABOUT THE COLLEGE?

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EQUAL OPPORTUNITIES MONITORING - RACE (*)
Scottish
English
Welsh
Irish
Black African
Black Caribbean
Black Other
Pakistani
Bangladeshi
Indian
Chinese
Asian Other
Mixed

Invalid Input We wish to ensure that every applicant is treated equally and fairly. Any complaint on the grounds of race discrimination should be sent in confidence to the Depute Principal.
NATIONALITY (*)

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HAVE YOU BEEN RESIDENT IN SCOTLAND FOR THE PAST 3 YEARS? (*)
Yes
No

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DO YOU HAVE A DISABILITY OR SUPPORT NEED? (*)
Yes
No

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ARE YOU REGISTERED DISABLED?
No
Yes - Not registered
Yes - Registered

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DISABILITY REGISTRATION NUMBER

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PLEASE INDICATE TYPE OF DISABILITY
Not known
Dyslexia
Blind/partially sighted
Deaf/hearing impaired
Wheelchair user/mobility difficulty
Personal care support
Mental health issues
Unseen disability
Multiple disabilities
Disability not listed

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SUPPORT
Support with English or Maths
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QUALIFICATION / YEAR / LEVEL / GRADE (*)

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SCHOOLS ATTENDED: FROM - TO

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HAVE YOU ATTENDED COLLEGE BEFORE? (*)
Yes
No

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IF SO, WHEN?

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WHICH COLLEGE?

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FOR WHICH COURSE?

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HAVE YOU RECEIVED A BURSARY BEFORE?
Yes
No

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WHEN?

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FROM WHICH SOURCE?

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SLC student number

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OTHER INFORMATION RELEVANT TO YOUR APPLICATION

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UNCONDITIONAL OFFER

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UNSUCCESSFUL

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WAITING LIST

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CONDITIONAL OFFER

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CO Qualifications

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CO Reference

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CO PVG

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CO Essay

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CO Test

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CO Other

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