FULL-TIME
STUDENT
APPLICATION
FORM

South Cheshire College

 INFORMATION CENTRE
Dane Bank Avenue
Crewe
Cheshire
CW2 8AB
Tel: 01270 654654
Fax: 01270 651515
E-mail: admissions@s-cheshire.ac.uk

Click on the "Submit" button at the end of the form once you have finished entering your information. This will send your application details to the College Information Centre. Items marked * must be filled in.

Please note - you only need to complete ONE application form per academic year, regardless of how many full time courses you apply for. If you decide to apply for a different course after you have submitted this form, simply telephone our admissions team on 01270 654630/631 and request that they add the new course to your application.

PART-TIME COURSES
Please do not use this form to apply for a part time course, please select the course you require from the course directory and follow the instructions in the "How do I Apply" section at the bottom of the course details page.
PERSONAL DETAILS
Surname/Last Name*
First Name(s)*
Date of Birth(DD/MM/YYYY)*
/ / 		Title*
Mrs  |  Mr  |  Miss  |  Ms  |  Dr 		Gender*
Male Female
Nationality*
 How many years have
you lived in the UK?
Please confirm that we may contact your parent or guardian by giving their name here.
House Number*
 Street*
Town*
County*
 Post Code*
Home Phone*
 Your Mobile
Your E-Mail
COURSE
If you are applying for AS or A2 courses please state each course code and subject
Course Code (from college web site)
 Course or Subject Title*
If you are uncertain about your course would you like a careers interview? Yes No
LEARNER SUPPORT
Please indicate if any of the following affect your learning or if you require support:
Dyslexia Visual Impairment Literacy/Reading/Spelling Not Applicable
Numeracy Deafness/Hearing Loss Other    
Please give further details:
 
 
HEALTH
Are there any aspects of your health which we need to be aware of, which may affect your learning, while you are at College?
(For example, acute asthma, epilepsy, impaired mobility or mental health		 Yes No
If yes, please state:
 
 
EDUCATION AND EMPLOYMENT
(Age 15-18 only need select)
 Date of leaving (year) 
If your school is not listed above please type it here
QUALIFICATIONS Grade
Course/Subject
 Expected
 Actual
REFERENCES
Please give the name and address of a referee. If you are still at school please use your headteacher and school address.
Name*
Address*
 
  Postcode*
ETHNIC ORIGIN
Bangladeshi African White & Asian White British
Indian Caribbean White & Black African White Irish
Pakistani Other Black White and Black Caribbean Other White
Other Asian Chinese Any other mixed origin Any other origin
EMPLOYMENT  
Employer From To
SUPPORTING YOUR APPLICATION
What is your career preference?
Tell us about your interests and hobbies
Data Protection: South Cheshire College processes the data on this form and information gathered within individual courses, as well as details of students' academic performance and learning support needs. This information is used to assess student learning needs and provide data that the college is required to hold and supply to government departments and other bodies. Such personal data is treated in confidence and will not be disclosed to any third party except where the college is required to do so by law. Our purposes for holding information and a general description of the categories of people and organisations to whom we may disclose it, are listed in the college's notification under the Data Protection Act 1998. Your submitting this form constitutes consent to this processing.