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Guidance notes on the completion of this application form
You should complete this form for a full-time course or for an apprenticeship. Completed forms should be submitted by the priority date of 30 June 2012. Your application will be acknowledged within two working days. Applications received after the priority date will be processed during the summer and applicants may be contacted by telephone to arrange an interview.
If any details of your application change after you have submitted it, please inform central admissions.
The name of the course you are applying for
Site (please consult the course page on this website or the relevant course guide to find out at which site your course is available): Beverley Bridlington Hull (music and media only) Other
If you chose "other", please give details:
Your details
Surname:
First name(s):
Date of birth:
Gender Male Female
Title (please tick one): Mr Mrs Miss Ms Other
If you chose "other" please give details:
Have you been ordinarily resident in the UK/EU during the last three years? Yes No
Date of entry to the UK (if applicable)
Have you been in the UK on a student visa? Yes No
Address (including postcode):
Telephone (home):
Telephone (mobile):
Email address:
If you are under 19 years old, which school/college are you currently attending or what school/college did you last attend? Please include the full address and postcode
Do you have any criminal convictions or cautions (non motoring)? Yes No
Personal information
Personal qualities as well as examination successes are important, please tell us about yourself below.
Interests/achievements
Experience of employment
What career do you have in mind?
Next of kin
Person we can contact in the event of an emergency. If you are under 18, please give details of parent/guardian who we may contact in relation to your progress at College
Name and address of next of kin:
Next of kin's telephone number:
Next of kin's relationship to you:
References
We will obtain a reference from your current or previous school or college, if you are under 19. If you have already left school, please supply the name and address of an employer/person who can be contacted for a reference.
Name, full postal address and contact telephone number
Examinations/qualifications
Please list below any examinations you have already taken, the grade you achieved OR any examinations you will take before starting your college course, with predicted grades. (Please consult your teacher or insert your mock exam results.)
GCSE subject and grade (please state whether these are actual or predicted):
Other qualifications:
Equal opportunities
Equal opportunities monitoring - East Riding College has an equality and diversity policy that warmly welcomes people from all backgrounds regardless of race, ethnic origin, gender, disability, religion, sexuality or age. Please help us to monitor the effectiveness of our policy by answering the following questions.
Have you any disabilities or health problems? Yes No
Are you registered disabled? Yes No
Do you have any other support requirements? Yes No
If you have answered YES to any of the three questions above, please give brief details:
What is your ethnic group? Please tick ONE from the following options:
Asian or Asian British Bangladeshi (11) Indian (12) Pakistani (13) Other - please give details below (14)
Black or black British African (15) Caribbean (16) Other - please give details below (17)
Chinese or Chinese British Chinese (18) Other - please give details below (98)
Mixed White and Asian (19) White and black African (20) White and black Caribeean (21) Mixed other - please give details below (22)
White British (23) Irish (24) Other - please give details below (25)
If you answered "other" above or belong to an ethnic group not mentioned above, please give details here:
DATA PROTECTION STATEMENT
Please read this Data Protection Statement carefully. By signing this Application Form you are indicating your consent to the collection and use of your personal data as set out below.We collect and process the personal data you provide on this Application Form to help us to decide whether to offer you a place on a course at East Riding college. If we offer you a place, it will be subject to us obtaining satisfactory references from your previous school, employer and/or other referee named on this Application Form.All of the data we collect about you is handled and stored securely in wither hard or electronic form within the College’s various departments. We ask for contact details or your next of kin so that we can contact him or her in an emergency. We may disclose details of medical conditions you have told us about to your potential tutor or to third parties where it is necessary for us to help safeguard your health and safety or the health and safety of others. We may also use this information to help us to tailor our facilities to your requirements. Details of your ethnic background are collected solely for the purpose of monitoring the promotion of equal opportunities within the College.We may use your personal data to send you information relating to the various courses and services we offer where we believe these may be of interest to you. We will neither sell your personal data to third parties nor disclose it to them for the purpose of direct marketing without your consent. If you do not wish us to send you information relating to the College’s own courses and services, please tick here [ ] or write to the Data Protection Officer at Longcroft Hall, Gallows Lane, Beverley, East Yorkshire, HU17 7DT with details of your request.We have notified the Office of the Information Commissioner of our data processing activities: our Data Protection Notification number is Z6977440. A list of third parties to whom we have disclosed personal data about you is available on request. We will give you a copy of the data which we hold about you upon payment of a fee.
By submitting this form, you declare that all the information you have given is correct to the best of your knowledge.
From Sep 2011.
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