Application Form

Thank you for your interest in Blackburn College.
If you need any help completing this application form, contact Student Services on 0844 2435499



1. ABOUT YOURSELF
Surname: First Name:
Gender: Date of Birth:
Home Address:
Postcode: Phone number:
Email Address: Mobile Number:
Have you been a permanent resident in the UK for the last three years?
If no, please specify country: Nationality:
Name of Parent / Guardian (if under 16):
Are you or have you been in the care of the local authority:
Name of Emergency Contact:
Relationship of contact person: Phone Number:

2. ETHNIC ORIGIN

Please select from the list:



In order for us to monitor the effectiveness of equal opportunities in our interviewing process, we would be grateful if you would
complete this section, though you do not have to do so if you do not wish. This information remains strictly confidential and is not used
as part of the interviewing process.

3. YOUR EDUCATION
Name of School: Date of Leaving:
4. EXAMINATIONS AND QUALIFICATIONS
Please state all the qualifications you are currently taking or have already completed, including the level (i.e. GCSE, Higher, Intermediate
or Foundation) and predicted/actual grade (if known).
Subject: Level: Grade - Predicted Grade - Actual
5. YOUR CHOICE OF COURSE
Which course are you applying for (You do not have to fill in all areas):
A Levels: please indicate the 4 subjects you are interested in:

Full-time Vocational Courses:
1st choice:

2nd choice:


APPRENTICESHIP Courses:
1st choice:
If you wish to apply for more than one apprenticeship course please complete the 2nd and or 3rd choice below.
2nd choice:

3rd choice:

National Insurance Number:

Employer Name:

Employer Address:

 

Part-time Courses:


 
6. EXTRA SUPPORT

Blackburn College is committed to ensuring that disabled people, including those with learning difficulties, are
treated fairly. If you are a disabled person, please ensure that we know what you need so that we can make all
reasonable adjustments to help you succeed.

Please tick if you feel you would benefit from extra support with any of the following (this will not affect your application):

Dyslexia
English
Learning Difficulties
Maths
Vision
Physical Disability
English as an additional language
Hearing
Medical Condition
Other
None

If 'other' please specify:


Data Protection

The information you provide on this application form will be stored and used by the College, which is registered under the Data
Protection Act 1998, for the primary reason of monitoring the progress of your application. The data may be shared with your school,
Connexions and the LSC. Blackburn College may use this data to contact you in the future.

Tick this box if you wish to opt out