Adult Courses / Part Time Application Form

Adult/Part Time Application Form

Applicant Details

Title *

Gender *

First Name *

Surname *

Date of Birth *

Address Line One * Please start typing your address in the box below and choose the correct one from the list. Your address will be filled in automatically

Address Line Two *

Address Line Three

Address Line Four

Postcode *

Phone Number *

Alternate Phone Number

Email Address

Nationality *

Ethnic Origin *

Courses Applied For

Course One

Course Code

Course Name *

Course Two

Course Code

Course Name

Qualifications

Qualification Name	Qualification Grade	Date Achieved
GCSE English			I do not have this qualification
GCSE Maths			I do not have this qualification
GCSE Science			I do not have this qualification

Please list any other qualifications you feel may be relevant to your course choice (e.g. O Levels, CSEs):
Please advise of any relevant work experience you may have:

Additional Information

I have a learning difficulty, disability or health need which affects my ability to study

I require additional support

PRIVACY NOTICE

The college will process the information provided in this form for the purposes of progressing your application or for education, training and administration purposes. We might share this information with third-parties, for example, your school, Connexions, ESFA or prospective employers for apprenticeship applicants.

Information will be processed in accordance with the college’s data protection policy. For more information about how we manage your personal data and your individual rights please visit the college’s website www.burycollege.ac.uk.

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