Don't forget you can come along and talk to tutors about your course options at our Open Events.. Make a note in your diary:
Thurs 21 June 2012 from 5.30pm - 8.30pm

APPLICATION FORM FOR FULL-TIME AND PART-TIME COURSES
STARTING 2012

Please complete all the fields of the form

Title of course applied for

First choice:

Second choice (if required):

Please tick relevant box  Full-time Part-time Day Part-time Evening

Personal Details

First name

Middle name(s)

Family name/surname

Title ---MrMrsMissMs

Male/female  Male Female

Date of birth Day---12345678910111213141516171819202122232425262728293031 Month ---JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Year ---2000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910

National Insurance Number (if received)

Age you will be on 31 August 2012 ---1415161718192021222324252627282930313233343536373839404142434445464748495051525354555657585960616263646566676869707172737475767778798081828384858687888990919293949596979899100

Permanent Address (where we can send letters to you)

Postcode

How long have you lived here at this address?

Have you lived outside the UK within the last 3 years?  Yes No

If yes, what date did you arrive and what is your status within the UK?

Home telephone number

Mobile number

Email address

If you are under 19 years old, please give the name and address of your last secondary school/college

Please state the main language spoken in your home

Your qualifications and training courses

Employment (completion of this section is optional)

If you have an employer, please provide their name and address

Employer's telephone number

What position do you hold?

Do you work  Full time Part time

Your interests

What jobs or careers are you interested in?

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

How did you first learn that the College provided a course to suit your needs? ---Present/past learnerFriend/FamilyCareers eventCareers ServiceCollege open eventLearner Help CentreSchoolEmployerTelephoneRadioBus advertisingPoster'The Post' newspaper'The Recorder' newspaper'The News' newspaper'The Express' newspaper'Yellow Advertiser'Other newspaperCollege websiteOther website (please specify)Other (please specify)

Are you an Ex-Offender, currently under Probation or Youth Offending Services?  Yes No

Additional Learning Support

Please tick this box  if you would like us to arrange a confidential interview to discuss the support options we can offer, to ensure that you can fully access your course. We can provide a range of support for learners, disabilities, learning difficulties and medical conditions, for example learners with dyslexia, visual and hearing impairments, mobility difficulties, mental health difficulties and epilepsy.

Please specify below the type and support you think you might need:

Declaration

I wish to apply to Barking & Dagenham College for a Further/Higher Education course.

Please fill in the following characters:

I wish to apply to Barking & Dagenham College for a Further/Higher Education Course. I agree that the College authorities may ask my last school or college and/or my present employer for references. I accept that personal details from this form will be used for internal administrative purposes only and will not be shared with any third party. The full Barking & Dagenham College Data Protection statement can be viewed on our website here http://www.barkingdagenhamcollege.ac.uk/wp-content/uploads/2011/09/Barking-Dagenham-College-Data-Protection-Policy-November-2010.pdf or alternatively mailed out upon request.

Submitted as signed:

Date:

By pressing the submit button, you confirm you have read the the Data Protection information and agree with the Declaration as set out above.