The Organ Academy Application Form

The Organ Academy Application Form

Please fill in all relevant details to the best of your knowledge. Any parts left unfilled could lead to your application form being rejected.The Organ Academy is an equal opportunity institution, and therefore this application will not be used for limiting or excluding any applicant from consideration for studying on a basis prohibited by local, state, or federal law.
Mr/Mrs/Miss/Ms/Other*
Upload Your Passport Photo*
Full Name*

First NameMiddle NameLast Name
Gender*

malefemale
Birth Date*

MonthDayYear
Nationality*
Country of birth*
Mobile Number*
Alternative Phone Number (optional)
Present Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Permanent Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*

Confirmation Emailexample@example.com
Person to contact in case of emergency:*
Parent/Guardian
Relationship*
ex. Father, Mother, etc.
Address of person to contact in case of emergency*
Course of Study Applied for:
Name of Programme:*
Highlight your Course choice
Mode of study:*

Full timePart timeRemote LearningOther
Proposed start date (Month,Year):*
Fees Information:

You must give details of who will be paying your fees.
Who is expected to pay your fees?*

YourselfSponsor
If Sponsor, Please provide contact Name, address, contact phone number and email to which invoice is to be sent (if different from above)
Education:

Please give details of all Schools/Colleges/Universities attended.

Secondary/Further/Higher Education

	Name of secondary School/College/University	Address	Dates Attended From(mm/yy)To(mm/yy)

Education Qualifications:

Educational Qualifications*

	Subject	Level (eg GCSE, BA, MSc)	Grade	Date(mm/yy)

Educational Language Qualifications

	Title of qualification	Awarding Body(and verification ID for TOEFL and IELTS)	Grade(including scores for individual skills if applicable)	Date(mm/yy)
1

Qualifications currently being studied (award pending)

	Subject	Level (eg GCSE, IB, BA, MSc)	Date(mm/yy)

Have you previously studied in Uganda?*

YesNo
Employment:

Please give details of current and previous employers, together with dates.

Type a question

	Organisation	Position held and summary of responsibilities	Date From(mm/yy)TO (mm/yy)

Statement In Support Of Application:

This section must be completed.You should state why you want to undertake this course,any relevant experience,skills and attributes, plus your long terms goals.
Statement
Reference:

All aplicants must provide one reference.The referee should be a course tutor if you have been in education within the last two years or your current or most recent employer.
Name of referee 1
Organization
Relationship to you
Reference enclosed/Reference to follow
Name of referee 2
Organization
Relationship to you
Reference enclosed/Reference to follow
Please tell us where you found out about this course
Support Requirements:

Please complete this section if you have any learning support/mobillity requirements.
Do you have a disability, medical conditon or require learning support?

YesNo
If yes,please name and give brief details:
Declarations:
Do you have any unspent criminal convictions?*

YesNo
A criminal record will not necessarily be a bar to obtaining a place at ZCBC College.

A satisfactory Criminal Records Bureau disclosure will be required for successful applicants to courses which include placements where students work with children or vulnerable adults.
Data Protection Act 1988

I agree to the academy processing personal data contained in this form or other data which the academy may obtain from other people. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any legitimate reason including communication with me following the completion of my studies.

In addition, I agree to the academy processing personal data described as ''Sensitive Data'' within the meaning of the Data Protection Act 1988, such processing to be undertaken for any purposes as indicated in the declaration above.

If my employer/sponsor is supporting my studies by paying my fees/allowing me study time, I agree to my employer/sponsor being informed of the progress of my application and of my studies if I am accepted onto the course.
Agent Referral

To be completed if applying with the assistance of an overseas recruitment agent

I confirm that I give authorisation to the agent below to discuss my application with staff at The Organ Academy and receive correspondence from TOA on my behalf.
Agent/Company
Contact Person
EMail
example@example.com
Telephone Number
Declaration

I certify that, to the best of my belief, the information I have provided is complete and true.
Applicant Names

First NameLast Name
Signature*

Clear
Date

daymonthyear
Should be Empty:

The Organ Academy Application Form

Course of Study Applied for:

Fees Information:

Education:

Education Qualifications:

Employment:

Statement In Support Of Application:

Reference:

Support Requirements:

Declarations: