City College Enrolment Form

Personal Details
Select Course
Intake
Name (as on your passport or birth certificate)*

TitleFirst NameMiddle InitialLast Name
Birth Date*

MonthDayYear
Age
Place Of Birth (As On Passport)*
NI Number
Address in the UK*

Line 1 (House/Flat Number, Street)

Line 2

CityState

Zip CodeCountry
Postcode*
Phone Number*
We will text you updates and date reminders, please ensure your mobile number is correct and advise us of any changes immediately to ensure you are kept up-to-date.
E-mail Address*
Check your email inbox on regular basis for any updates from us.
Gender*
Sexual Identity*
Ethnicity*
Religion*
Emergency Contact

Please enter the details of someone we can contact in case you were to have an emergency in the college.
Emergency Contact Name*

First NameLast Name
What is their relationship to you? (Please select)*
Emergency Contact Phone Number*
They will only be contacted if you have an emergency in the college building, or if any of our staff members feel you are in danger.

Previous Qualifications

Please list any formal qualifications you may have received in the past.
Please select your Highest Level of Previous Qualifications*
Where did you get your qualification(s)?*
Have you any studied Level 4/5 (HNC/HND) course before?*
If YES, please mention the previous course name, college name and the year you completed it or withdrawn from the course*
Do you have an English Qualification?*
Do you have a Maths Qualification?*
Learning and Support Needs
Do you consider yourself to have a disability?*
If Yes, please specify your disability*
Do you need any additional support or reasonable adjustments for either the interview or for the course?*
If Yes, please specify the support or adjustments that you need*
Do you suffer from any of the conditions listed below? *
If you have one or more impairments or conditions, please provide details of them so that we can create a customised plan for any additional support you may need*
Do you have personal access to the internet and a computer/laptop?*
Nationality and Residency
Passport Type*
Nationality*
Country of Birth*
Please select your current Residency Status in the UK *
Do you have recourse to public funding*
Have you been PERMANENTLY RESIDING* in the UK/EU/EEA for the past 3 years?*
If selected 'No' mention where you have lived for 3 years*
Financial and Employment Information
How do you intend to fund your study?*
Have you applied for student finance before*
If selected 'Yes' please mention in details how many years of funding you have received. *
Your Current Employment Status*
How long have you been unemployed?*
Please state any work experience (eg 2008-2010 Manager at XYZ company)*
Job Title*
How long have you been employed / self-employed?*
Your Employers Name*
Your Employers Contact Details (phone number OR email address)*
Have you had any of the following experience in your current or previous job? *
Personal Statement

These statements will be used to assess your eligibility - please be as descriptive as possible in answering the questions below. You can also add anything else relevant that you think would help your admission.
Why do you wish to study your chosen qualification and what do you hope to achieve after completing the course? (Minimum 80 words, maximum 100) *

0/100
What kind of student can we expect you to be ? (Minimum 70 words, maximum 100) *

0/100
Declaration of criminal record
Have you ever had a criminal conviction?*
If YES, please describe the nature of the conviction and dates.*
Keeping in touch
We would like to keep in touch to keep you informed of any student events, information or workshops at CC Recruitment Services that may be of interest to you. Please select "YES" to be included.*
How did you hear about us?*
Please mention the name:*
Referral Scheme

Earn up to £750 per referral! All you need to do is give us their name and contact number and we will do the rest.
Name and Contact Number
Student Declaration
Signature

Clear
Current Date

MonthDayYear
Date
Should be Empty:

Personal Details

Emergency Contact

Previous Qualifications

Learning and Support Needs

Nationality and Residency

Financial and Employment Information

Personal Statement

Declaration of criminal record

Keeping in touch

Referral Scheme

Student Declaration