Educational Psychology and Data Protection Essay example

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Application and Enrolment Form

Section 1. Course Details (Please use CAPITAL LETTERS)
I want to study:
I want to start in:
YYYY

I want to study:
 Full-time  Part-time

Section 2. Personal Details
Mr/Ms/Miss/Other:
First name(s):
Last name:

Date of birth:
DD / MM / YY
Age:

Gender:
Previous last name (if changed):

National Insurance no:
Car registration no:

Unique learner no.
(if known):

Last school/college attended:
Address:

Postcode:

Usual permanent address (if different):
Email:

Tel (Home):

Tel (Mobile):
Emergency contact details:
Name:

Tel (Home):

Relationship:

Tel (Mobile): Tel (Work):
If you are under 19, please supply parent/guardian email:

Section 3. Nationality
Nationality:

Where were you born?
Where do you live now?

How long have you lived in the EU?
If you’ve lived here for less than 3 years please tell us your date of entry into the EU/UK: DD / MM / YY

Please tick if any of the following apply to you:
 Dependant
 Asylum seeker
 Refugee
 Indefinite leave to remain
 Limited leave to remain State expiry date: DD / MM / YY

Please supply supporting evidence including passport.
Do you have any unspent convictions or pending court cases?
 Yes  No

The student has been assessed on entry to their Learning Programme as requiring additional support: Yes / No
Level on Entry: 1 2 3 4 5 6 Date application received: Date enrolled:
Section 4. Support Services
In order that Guildford College can provide appropriate support for you, please tell us about any particular health, educational or domestic issues you may have. Any medical information you provide will be shared with the appropriate people in the case of an emergency situation. Please tick all that apply and give further details on a separate sheet if necessary:
 01 Blind/visual impairment
 02 Deaf/hearing impairment
 03 Mobility difficulties
 04 Other physical difficulties

 05 Epilepsy/asthma/diabetes
 06 Emotional/behavioural difficulties
 07 Mental health issues
 10 Aspergers

 90 Multiple disabilities
 97 Other
 98 No disability

Do you have a medical condition which significantly affects daily life? Please give details on a separate sheet:
 I have to carry routine/prescribed medicines
 I am receiving medical treatment by my GP/hospital
 I have an EpiPen for anaphylactic shock recovery

 I have been given medical advice to follow in an emergency
 Have you any other learning or health conditions you would like to discuss?
 01 Moderate learning difficulty
 02 Severe learning difficulty
 10 Dyslexia
 11 Dyscalculia
 19 Other specific learning difficulty
 20 Autism spectrum disorder
 90 Multiple learning difficulties
 97 Other
 98 No learning difficulty
 Have you had learning support before?
 Have you had special arrangements for exams before?

Section 5. Ethnicity
Monitoring of ethnic origin. Completion is voluntary and information supplied will be used only for statistical purposes and will be treated as confidential. Please tick the group to which you belong:

 31 White - British
 32 White - Irish
 34 White - any other
White background
 33 Gypsy or
Irish Traveller
 42 Chinese

 41 Asian or Asian
British Bangladeshi
 39 Asian or Asian
British - Indian
 40 Asian or Asian
British - Pakistani
 43 Asian or Asian British - any other Asian background  44 Black or Black
British - African
 45 Black or Black British
- Caribbean
 46 Black or Black British - any other Black background  47 Arab

 37 Mixed - White and Asian
 36 Mixed - White and Black African
 35 Mixed - White and Black Caribbean
 38 Mixed - any other
Mixed background

 98 If none of the above, please specify details:

Section 6. Reference and Employment
If you are currently in full-time
Show More

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