Short Courses APPLICATION FORM. Please list the course(s) you would like to study.

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1 BIRMINGHAM CHRISTIAN COLLEGE Crowther Hall, Hamilton Drive, Birmingham, B29 6AJ Tel: Please fill in this form, save a copy and to or send by post.. Short Courses APPLICATION FORM PHOTO Surface mail: Please affix recent passportsized photograph and enclose one other copy. Please jpeg format recent passport-sized photograph COURSE Please list the course(s) you would like to study. NAME/ CONTACT DETAILS FAMILY CONTEXT Surname: Title (Mr/Mrs etc) Other names: Sex (M/F): Name you prefer to be called by: Date of Birth: Nationality: House Number/Street: Area/Locality: Town/City: County/Province/State: Country: Postcode/Zip: Tel: Mob: Single Engaged Married No. Dependent Children Divorced Widowed Separated

2 DISABILITY /PHYSICAL Do you have any physical disability that might affect your studies or residential needs? If so, please give details: DISABILITY /LEARNING Do you have a learning difficulty that might affect your studies? If so, please give details: MEDICAL / HEALTH Do you have a health problem that might affect your studies or residential needs? If so, please give details: EMERGENCY CONTACT Surname: Other names: Relationship to Applicant: House Number/Street: Area/Locality: Town/City: County/Province/State: Country: Tel: Title (Mr/Mrs etc) Sex (M/F): Postcode/ZIP: Mob:

3 EDUCATION AND TRAINING GCSE/GCE O level or equivalent - subjects and grades: A level or equivalent - subjects and grades: Further Education awards, including awarding institutions and years: Higher Education Certificates, Diplomas & Degrees or equivalents, including awarding institutions and years: Other practical, Christian or ministry training:

4 ENGLISH LANGUAGE ABILITY For students whose first language is not English: Please tick as appropriate: I do not have English as a first Language All my secondary and higher education was through the medium of English ESOL/EFL test results (IELTS, Cambridge or equivalent). Please note a formal test is MANDATORY unless you have ticked the second box above. What is your present ability level in English? (Elementary, Intermediate, Advanced) Speaking..... Listening Comprehension..... Writing... Reading Comprehension.... RESIDENCY DETAILS Do you hold UK or EU Citizenship? Have you lived in the UK/EU continuously, with the exception of holiday periods, since birth? If NO please state precisely where you have been resident during the last 10 years (including periods spent in further/higher education). Is there any restriction on your eligibility to reside / work in the United Kingdom? If the answer is YES please specify such restrictions. WORK Employed Unemployed Student Training Carer Other Current details: Previous employment:

5 OTHER RELEVANT EXPERIENCE Please give any experience in Christian service or ministry relevant to this application: TRAINING OPTIONS Have you applied for any other College(s)? If, so which one(s) and with what result? Where did you hear about Birmingham Christian College Can you say why you have applied to this particular college? During the period of your proposed study will you be registered simultaneously for any Higher Education or other qualification? If YES, please give details:

6 REFEREES Counselling Courses ONLY. Please give us the names and addresses of TWO people to whom we may write (remember to ask them first). At least one should be able to comment on your vocational development, and one on your academic ability. (1) Surname: Title (Mr/Mrs etc) Other names: Sex (M/F): Relationship to Applicant: Housenumber/Street: Area/Locality: Town/City: County/Province/State: Country: Postcode/ZIP: Tel: Mob: (2) Surname: Title (Mr/Mrs etc) Other names: Sex (M/F): Relationship to Applicant: Housenumber/Street: Area/Locality: Town/City: County/Province/State: Country: Postcode/ZIP: Tel: Mob: LEGAL ISSUES Do you have any criminal convictions (excluding motor offences for which a fine and/or up to 3 penalty points were imposed)? If applicable, please give details with dates:

7 This section is for applicants resident in England, Wales, Scotland, Northern Island, the Channel Islands or the Isle of Man ONLY. This information is collected for statistical purposes only. Please tick the relevant box. I would describe my ethnic origin as: White British Other White Background Other Asian Background White English Black or British Caribbean Chinese White Irish Black or British African Mixed White & Black Caribbean Irish Scottish Other Black Background Mixed White & Black African White Welsh Asian or British Indian Mixed White & Asian White Traveller Asian or British Pakistani Other Mixed Background White Irish Traveller Asian or British Bangladeshi Other Ethnic Background You are free to decline to answer this question, in which case, please tick this box DECLARATION I have answered the questions as honestly and as accurately as I can. Signed: Date: Counselling courses: Please complete the written exercise below.

8 COUNSELLING COURSE APPLICATION Written exercise In no more than 200 words, please respond to the question Why counselling?

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