Havering Cllege f Further & Higher Educatin Curse Applicatin Frm Applicants name: Fr Cllege Use Only Student ID Date Entered Entered by Curse Cde Curse Title Ntes fr Applicants Please check the entry requirements fr the curse yu are interested in t make sure yu meet the entry criteria. This infrmatin can be fund in the prspectus r by cntacting the Admissins Team. Please remember yu can nly attend 1 full time curse at a time, but yu can apply fr up t 3 different curses. It is imprtant that yur applicatin includes a reference and predicted grades. If we dn t receive a reference we will cntact yur schl, hwever we will nt be able t invite yu t an interview r prcess yur applicatin until we have received this infrmatin. If yu are 19 r ver and applying fr a full time curse, we will accept a reference frm an emplyer r smene wh knws yu well (but nt a relative). Again, yu will nt be invited t attend an interview until we have received this infrmatin. If yu are under 18 please ask yur parent/guardian t sign yur applicatin. Cmpleted frms shuld be returned t: Threshld Services Havering Cllege f Further & Higher Educatin Ardleigh Green Rad Hrnchurch Essex RM11 2LL If yu have any questins abut cmpleting this frm please email admissins@havering cllege.ac.uk r phne 01708 462833 Cllege stamps
Persnal Details Last Name(s) First Name(s) Date f Birth Title: Mr Miss Ms Mrs Gender M F Email address Hme Address: Tel Hme: Mbile: Pstcde Name f Parent/Guardian: Address f Parent/Guardian (fr Applicant under 18 if different t abve) Tel Hme: Mbile: Residency Have yu been permanently resident in the UK r EU fr the past 3 years? Yes N* Is there any restrictin n the time yu may stay in the UK? Yes* N If * bx ticked please prvide brief details f hw lng yu have been resident in the UK and the circumstances f yur arrival and stay in the UK: Learner Supprt We prvide a range f supprt fr learners with disabilities and learning difficulties, including mbility difficulties, visual impairments, D/deaf, mental health difficulties, medical cnditins such as epilepsy, and specific learning difficulties such as dyslexia. Wuld yu like a cnfidential interview t discuss supprt? Yes N Have yu received any kind f additinal supprt fr examinatins? Yes N If YES please tick hw we can cntact yu By phne Phne number TICK By fax Fax number TICK By mini cm Mini cm number TICK By email Email address TICK Interests & Achievements Include yur interests and any psitins f respnsibility, part time emplyment and ther relevant infrmatin
Chice f Curse Are yu applying fr (please tick) 1. Full time study (3 5 days per week at Cllege) 2. Wrk based Learning T apply fr wrk based learning yu need t have a jb. If this is the case please give us yur emplyer s name and address. Please let us knw which curse yu wuld like t apply fr 1. COLLEGE 2. USE 3. ONLY Briefly, tell us yur reasns fr chsing this curse (include career/further study aims) Exam Details External Examinatin Recrd Subject /Curse Type f exam (e.g., GCSE) Date f exam Predicted Grade Grade achieved if exam already taken Schl/Cllege/Emplyer Details Please give us details f yur schl, cllege r emplyer Schl/Cllege/Emplyer name Schl/Cllege /Emplyer address Pstcde Dates yu attended schl/emplyment: Frm: T:
Reference Details Please ask yur Referee (Schl/Cllege r Emplyer) t cmplete the attached Reference Frm. If this is nt included in yur applicatin when we receive it we will cntact yur schl directly (Under 19 nly). Hwever we will nt be able t invite yu t an interview r prcess yur applicatin until we have received this infrmatin. Equal Opprtunities We are required t ask this questin in rder t assess the extent f representatin f ethnic grups in relatin t ur Equal Opprtunities plicy. Yur answer des nt affect the utcme f yur applicatin. Hw wuld yu describe yur ethnic backgrund? (please tick) 11 Asian r Asian British Bangladeshi 19 Mixed White and Asian 12 Asian r Asian British Indian 20 Mixed White and Black African 13 Asian r Asian British Pakistani 21 Mixed White and Black Caribbean 14 Asian r Asian British any ther Asian backgrund 22 Mixed any ther Mixed backgrund 15 Black r Black British African 23 White British 16 Black r Black British Caribbean 24 White Irish 17 Black r Black British any ther Black backgrund 25 White any ther White backgrund 18 Chinese 98 Any ther 99 Prefer nt t say/nt knwn Declaratin/Cnsent t Prcess (Data Prtectin Act 1998) Data cllected n this frm may be cmputerised, and is used bth fr statistical purpses within the Cllege and its Funding bdies, and fr sharing analysis with Schls, Clleges, Funding bdies and Lcal Authrities. I cnfirm that the infrmatin prvided n this frm is crrect t the best f my knwledge, and cnsent t this data being used as abve: Signature f Applicant: Date: If the Applicant is under 18: I agree with this applicatin t the Cllege, and will ensure cmpliance with the Cllege Regulatins: Parent/Guardian: (Signature): (Name): Date: Please make sure yu have fully cmpleted yur applicatin frm befre returning it t us. If yu have nt received an acknwledgement letter frm us within 2 weeks f returning yur applicatin please cntact us. If yu have any questins abut cmpleting this frm please email admissins@havering cllege.ac.uk r phne 01708 462833
Student N: Fr Office Use Only Havering Cllege f Further & Higher Educatin Reference Frm Applicant Details (t be cmpleted by the applicant) Name Address Pstcde Date f Birth Cntact Number Curse applied fr Ntes fr Referees: If the applicant is under 19 and requires If yu are prviding a character r an academic reference please cmplete emplyer reference, please cmplete all sectins. All references frm schls sectins D and E. MUST SHOW A SCHOOL STAMP FOR VERIFICATION Sectin A Please tick the apprpriate bxes belw Has ptential fr successful study Cmmitment t study Relatinship with peer grups Cperatin with teachers Cmmunicatin skills Quality f wrk Behaviur Mtivatin Attitude t schl/cllege/wrk envirnment Pr Average Gd Excellent Attendance % If attendance r punctuality are belw 90% please prvide details fr this: Punctuality % Sectin B Has the pupil a Cnnexins, Scial r Yuth Wrker? Yes N Name: Cntact details: Has the Pupil identified Special Educatinal Needs? Yes N Are these Needs? Schl Actin Schl Actin Plus Statemented Please prvide further details where pssible Signed Psitin Name in BLOCK CAPITALS Date
Sectin C External Examinatin Recrd Subject/Curse Type f Exam (eg, GCSE) Date Predicted Grade Grade Achieved (if exam already cmpleted) Sectin D Hw lng have yu knw the applicant? year(s) mnth(s) In what capacity d yu knw the applicant? Please cmment n the applicant s nn academic values and achievements (character, scial awareness, grup skills etc) Sectin E Name f Referee Signature f Referee Psitin Address Date Pstcde Nte fr Referees When persnal cmments are written cncerning an applicant, please remember that under the Data Prtectin Act, the applicant can ask fr a cpy f the reference and any ther persnal infrmatin that we have abut them. Cntact number Official Schl Stamp Please return t: Threshld Services, Havering Cllege f Further & Higher Educatin, Ardleigh Green Rad, Hrnchurch, Essex RM11 2LL admissins@havering cllege.ac.uk Telephne : 01708 462833