Filling Out Your Application Form by mby20700


									 Filling Out Your
 Application Form
    Apply NOW
 Please follow the check list below when
 you are completing your Application
 Form for a place at Harlow College.

     Check List
     Please complete your Application Form
     clearly in blue or black ink
     Include your first name in full, not just
     an initial
     Try to give as much information as
     possible. This helps us to ensure that
     you are making an application for a
     place on a course /Apprenticeship that
     best suits your needs and plans for
     the future
     Give the Progression Information Form
     to a suitable person who can provide
     an academic reference i.e. a school         Please note:
     teacher or college tutor                    We will use both your Application and Progression
                                                 Information Form at interview. If you are having any
                                                 difficulty in either:
                                                 • filling out your Application Form or
                                                 • getting someone to complete the Progression
                                                   Information Form for you,
Return your Application and Progression          please contact our Admissions Team:
Information Forms to:
                                                 BY TELEPHONE:
The Admissions Team,
                                                 (01279) 868145
Harlow College, Velizy Avenue,
Town Centre, Harlow, Essex                       BY E-MAIL:

CM20 3LH                               

                               Once we have received your Application and Progression
                               Information Forms for either a full-time course or an
                               Apprenticeship we will send you an interview date.
Personal Details
Surname                                                  First Name                                             Male        Female
Post Code                                    Tel No.                                    Mobile No.
Date of Birth                                Age on 1 September                            e-mail
                                             (of year course starts)
                   Name and address of school/college last attended                                    From                   To

 Name and address of parent or carer (if applicant is under 18 years or if parent’s or carer’s address is different from above)
 Name                                                                                   Tel No.
 Address                                                                                             Post Code

Your Nationality
Have you lived abroad other than holidays over the last 3 years?             Yes      No
If Yes, please state date of entry to UK                       Please attach photocopy of passport details plus entry/visa stamp
Country of normal residence (if not UK)
Country of Birth (if not UK please attach a photocopy of passport details)

Subjects or Courses you wish to study
Diploma (Introductory/First/National)
Apprenticeship/e2e                                                     NVQ
Other (please specify)
Don’t worry if you are not sure which course you want to study. We can arrange for you to come in and talk to our
Careers Guidance Team who can help you choose the option which is best suited to you.
Tick this box if you would like to talk to someone from our Careers Guidance Team

For Apprenticeships only
Your National Insurance Number
If you have a job or training place with an employer please give us details.
Company name                                                           Contact

Study Support
Do you have any learning needs that you wish us to know about so that we can provide appropriate support to you
in your studies? Yes       No     If you have ticked yes is this:
Because of a learning difficulty?              Because you need support with reading, writing, spelling or maths?
Because of a medical condition?                Because English is not your first language?                     Dyslexia?

Additional Support
The college seeks to achieve the objectives in the Disability Discrimination Act Part 4. If you are a disabled person,
please ensure that we know what you need so that we can make all reasonable adjustments to help you succeed.
Do you have a disability or a learning difficulty?      Yes       No
If yes, we want to help you get the best from your course. How would you wish to let us know what you are likely to need?
   By talking confidentially to a member of staff at interview
   By talking confidentially to a member of staff by: telephone               minicom          in writing     (please attach)
   Through someone else such as an advocate, parent or carer, who will accompany you to your interview
 Previous school/college and qualifications
                                                                                       GCSE, A/AS Level, Expected result         Actual result
                                   Exam subjects
                                                                                           NVQ.                                   (if known)

 Personal and career interests
 We want to make sure that you get the most out of your time at college, so please tell us a little more about yourself and
 your plans for the future
  Why do you want to come to college and study?

  What careers are you interested in? What job or career do you see yourself having in the future?

  What hobbies and interests do you have? Do you do any voluntary work or belong to any clubs?

 Equal Opportunities Monitoring
 Please tick the ethnic group that best describes you
 Asian or Asian British:     Bangladeshi                          Indian                   Pakistani          Any other Asian background
 Black or Black British:           African                   Caribbean                                        Any other Black background
 Mixed:                     White & Asian          White & Black African         White & Caribbean           Any other Mixed background
 White:                            British                         Irish                                      Any other White background
 Chinese:                         Chinese

 Progression Information Form
 We will require some information from your school/college. If you have not been in education for several years we will need a
 reference from your employer. Please tell us the contact details for the person you will be giving your Progression Information form to.

 Post Code                                   Tel No.

 I confirm that the information I have given here is correct

 Sign here                                                        Print your name                                             Date

 If you are under 18, please ask your parent/carer to sign here                                                               Date

Please return this form to: The Admissions Team, Harlow College,
Velizy Avenue, Town Centre, Harlow. CM20 3LH (01279) 868145
Data Protection: Information you provide on this Application Form will be held on file at Harlow College. The College has submitted the
relevant Notification to the Information Commissioner’s Office within the terms of relevant legislation, and complies with all of the provisions of
that legislation to all learner data. Further information about data confidentiality is available upon request.
(Applicants are not interviewed until this form is completed and returned)
If you are applying for a place at Harlow College please complete the first box and pass the form to your last
school/college attended.
School/college staff. This form is used to provide us with information on the applicant’s progress, any particular
needs that they have and the support that they require.
Please return this form to The Admissions Team,
Harlow College, Velizy Avenue, Town Centre, Harlow, Essex. CM20 3LH

  Applicant Surname                                                  First Name

  Choice of course/Apprenticeship

 1. The information in this section may be replaced by a print out from your school’s information system.
 Estimated examination grades
                                             GCSE/Diploma/NVQ etc. (Foundation, Intermediate            Grades
                   Subject                        and Higher Level where appropriate.)           Predicted   Known
  English Literature

  Other qualifications

 Attendance and Punctuality

 Attendance              90 - 100%                80 - 90%                   Less than 80%

 Lates                   Under 3%                 3 - 5%                     Over 5%
                         < 10 lates               >< 10 - 20 lates           > 20 lates

  Please explain any mitigating factors relevant to grades or attendance and punctuality
 2. Please tick the appropriate boxes

                                         Excellent          Good               Acceptable    Poor
 Motivation and effort
 Ability to work independently
 Ability to work with others
 Relationship with peers
 Relationship with staff
 Ability to meet deadlines

  Please provide further details of any personal circumstances or issues, including strategies the school/college
  uses to support the applicant and progress being made.

 Is the applicant on the SEN Register? If yes, at which level?

 Statement                 School Action Plus                  School Action

 Does the applicant receive any additional support?

     Help with general reading, writing or spelling
     Help with essay writing
     Help with English if it is not the applicant’s first language
     Help with dyslexia/specific learning difficulties
     Help with maths skills
     Help with mobility about the college and the use of facilities
     Help in lessons/examinations because of hearing impairment
     Help in lessons/examinations or with books and printed material because of visual impairment
     Help with social skills/relationships

  Does the applicant have a medical condition that we may need to know about? If yes, please give details.

 Name (please print)                                           Signature


 Position                                                                                    Date

                           Thank you very much for the time you have given
                           to complete this Progression Information Form

Harlow College Velizy Avenue Town Centre Harlow Essex CM20 3LH Tel (01279) 868145

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