Apply for a Course

Part-time Application Form

Please read the guidance notes before completing this application form.

Course Title

First Choice

Course Code

First Choice Code

Your Details

First Name

Last Name

Address

Postcode

Gender

Male

Female

Date of Birth

Telephone

Mobile

Email

Nationality

Date of Entry in to UK (non-EU students only)

Have you lived in the UK or an EEA country for the 3 years preceding the start of your course?

Yes

No

Next of Kin Contact Details

Name

Relationship to you

Email

Contact Number

Please list (in date order) any exams that you are taking and any results you have already achieved.

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

Exam/Award Body (e.g. BTEC/GCSE)

Level (e.g.L1 Diploma)

Subject

Predicted result

Result (if known)

Date of result

How did you hear about this course?

Other (please state)

The college welcomes applications from students with disabilities and learning difficulties. If you consider that you have a disability or learning difficulty, please tick any of the boxes so that we may discuss your needs in confidence and help wherever possible.

I have a disability and will need support

I am dyslexic and would like support

English is not my first language

I would like support/have particular requirements for my interview

To help us make sure the college is serving the whole community, please indicate your ethnic origin by ticking one of the boxes below

Please ensure that you have completed all the relevant sections to avoid unnecessary delays in processing this application.

I certify that I am over the age of 18

At West Herts College we take your privacy seriously and look after your personal data as if it was our own. In compliance with the General Data Protection Regulation, the information you share on this form will only be kept for the required amount of time as detailed in our Retention Schedule. Our support teams may need to contact you regarding your application/enrolment using the details you have provided in this form – this may be done by telephone, email and post. Your data will only be shared with third-party organisations where it is legally required, e.g. Government funding agencies, exam boards etc.

We may wish to contact you by email from time to time regarding wider updates, such as news on new courses, offers and college events. If you would like to receive these updates, please opt in below.

Opt In

Signature

Date

Signature of parent/guardian (if applicant is under 18)

Date

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