Application Form - York College

OFFICEUSE ONLYApplicantRefStudentRefApplication FormFor all courses. Please read the attached guidelines before completing this form.Complete all sections in BLOCK CAPITALS and BLACK INK (tick where appropriate).York College is committed tocreating an environment where there ismutual respect and equality of opportunity1 Personal DetailsSurname/Family NameMaleFemaleForename/Given NameMiddle Name(s)TitleMr / Mrs / Miss / MsDate of BirthAge at 31st August in proposed year of enrolmentHome addressWhat has been your normal country of residence during the last threeyears?eg: England, Scotland, Wales ,N. IrelandNational Insurance No.Home Tel.Personal MobilePostcodePersonal Email2 Emergency ContactPlease provide the name, address and telephone number of someone we can contact in the case of an emergency. This should be your next of kin.This must be your parent/guardian if you are under 18.NameAddress(If different fromhome address)Relationship to YouPostcodeTelephone3 Course(s) Applied ForCourse Title Level (if known) Full-time or Part-timeeg: BTEC Diploma in Sport Level 2 Full-timeeg: AAT Certificate in Accounting Level 3 Part-timeWould you like to be considered for the Sports Development Centre in addition to your course?If Yes, please state which sport.Rugby Football BasketballWould you like to be considered for the Music Development Centre in addition to your course?If Yes, please state which instrument and level.YESYESNONO4 How did you find out about the course(s) you are applying for?York College Website Other Website Course Guide or Course Leaflet Talk at School Friend/FamilyOther, please state.All documents can be made available in alternative formats.du7034

5 Education Details (If under 19)Name of most recent School or CollegeTown/City6 QualificationsPlease list all qualifications about to be taken or already taken.Qualification/Level Subject EstimatedGradeActualGradeExam Board(if known)Year ofCompletioneg: GCSE English Language B Edexcel 20137 Employment Status (Only complete if 19 or over)Are you in paid employment? YES NOIf Yes, will your employer/sponsor be contributing to your course fees? YES NOIf Yes, please complete details below.Employer/Sponsor DetailsCompany Name/ContactAddressPostcodeTelephoneEmail8 Referee• Please complete the details of your nominated referee below.• Please detach the reference form (Section 14) and pass to your nominated referee. Please ensure you complete your name, date of birth and thecourses you have applied for at the top of the form.• Your completed reference form should be returned by your referee to Admissions Team, York College, Sim Balk Lane, York YO23 2BB.NameAddressPostcodeTelephoneEmail AddressPositionRelationship to Applicant9 Criminal ConvictionsDo you have an unspent criminal conviction? YES NOIf yes, this will be discussed at interview. An unspent criminal conviction does not necessarily preclude you from entry to a course, but a second referencemay be required. However, in the event of being admitted to a course any failure to disclose any unspent convictions may result in the college asking you towithdraw.

10 Support with Your LearningPlease tick if any of the following apply to you.Visual ImpairmentHearing ImpairmentDisability Affecting MobilityPhysical DisabilityMedical Condition:EpilepsyAsthmaDiabetesEmotional/Behavioural DifficultiesMental Health DifficultyTemporary Disability(eg: after accident, illness)Profound/Complex DisabilitiesAspergers SyndromeMultiple DisabilitiesCommunication/SpeechImpairmentOtherModerate Learning DifficultySevere Learning DifficultyDyslexiaDyscalculiaSpecific Learning DifficultyAutism Spectrum DisorderMultiple Learning DifficultiesOtherDo you require support with:LiteracyNumeracyI am happy for information to be passed on to staff to arrange support. YES NO11 Personal Statement (This section must be completed)Please provide a brief statement about how the course(s) you are applying for will help you achieve your aims.The following headings may help you complete this section.Please tell us why you are interested in the course(s) you have applied for.What do you think you might do after you have finished your course?Please tell us about your main achievements. (eg Duke of Edinburgh, sporting achievements, etc.)Please tell us about your work experience and/or voluntary work.What do you do in your free time?

Please complete all sections in BLOCK CAPITALS and BLACK INK (tick where appropriate).Student RefOFFICE USEName of ApplicantDate of BirthCourse(s) applied for14 ReferenceThe college would be pleased if you could complete this section outlining your view on the suitability of the applicant for the course(s) chosen.When complete, please return to Admissions Team, York College, Sim Balk Lane, York YO23 2BB.Assessment of potential (please tick)Motivation: Good AveragePoorGeneral Behaviour: Good Average PoorPunctuality: Good Average PoorAttitude to Learning/work: Good Average Poor Attendance: Good Average PoorSuitability for the course applied forGeneral quality of workAny additional information (eg. include any indications of additional support needs or any involvement in extra curricular activities, if applicable)If known, has the applicant ever been excluded from school or been the subject of disciplinary action?Yes No Don’t Know Not ApplicableReferee NamePositionReferee SignatureDateEmployment AddressTelephoneEmail AddressHow We Use Your Personal InformationThe personal information you provide is passed to the Chief Executive of Skills Funding (“the Agency”) and, when needed, the Department for Education, including the Education Funding Agency to meet legal responsibilitiesunder the Apprenticeships, Skills, Children and Learning Act 2009, and for the Agency’s Learning Records Service (LRS) to create and maintain a unique learner number (ULN). The information youprovide may be shared with other partner organisations for purposes relating to education or training. Further information about use of and access to your personal data, and details of partner organisations areavailable at: http://skillsfundingagency.bis.gov.uk/privacy.htm and http://www.learningrecordsservice.org.uk/documentlibrary/documents/code+of+practice+for+sharing+of+personal+information.htm

Dear Sir / MadamThe person named on the other side of this form has applied to study a course at York College.They have listed you as a referee who will provide information in support of their application.We would be grateful if you could complete the reference form overleaf outlining your viewof the suitability of the applicant for the courses chosen.When completed, please return to:Admissions TeamYork CollegeSim Balk LaneYork YO23 2BBMany thanks for taking the time to complete this request on behalf of the applicant.Yours faithfullyDr Alison Birkinshaw OBEPrincipal and Chief Executive

Section 8: RefereeThis section asks for the name and address of one referee. Thisshould be someone who is able to comment on your academicability, for example your school tutor. If you are a mature studentyou could use a previous or current employer. There is a referenceform provided in Section 14, which should be detached andpassed to your referee. The referee should then complete the informationrequired and post back to the York College AdmissionsTeam.Please note for Child Care courses a Criminal Records Bureau (CRB)check will be necessary. This will take place before your coursestarts or during your course if you start a work placement. Therewill be a charge for this.Section 9: Criminal ConvictionsPlease indicate if you have any unspent criminal convictions. If yes,the college may then ask you for more details.Section 10: Support with Your LearningThis information is collected so that we are aware of any additionalsupport you may need. Please tick any relevant box(es) and indicateif you are happy to be contacted to talk about types of supportthat can be provided.York College is committed to equality for all and widening participationfor disabled students and ensuring that all students haveaccess to a high quality learning experience. To help us achieve thisplease make sure that you let us know what you need so we canmake reasonable adjustments to help you succeed.Section 11: Personal Statement(This section must be completed)Please fill in the different sections with as much detail as possible.This gives us an insight into your motivations for applying to yourchosen course and what you hope to do in the future.Section 12: Ethnic GroupTick which box you think best describes yourself. The informationis not used as part of any decision connected with your application,but helps us to monitor our equality policy.Section 13: Declaration and SignatureThis section asks if you have read these guidance notes and thatthe information you have provided in this application form is correct.Section 14: ReferenceStudents should fill in their name and course(s) applied for in theboxes provided at the top of the page. Students who are still atschool should pass the completed application form to theirteacher in order for them to fill in their reference and estimatedGCSE grades. Mature students may wish to detach this page inorder to pass the reference pro-forma to their chosen referee.Please return your completed form to:Admissions TeamSim Balk LaneYorkY023 2BBWhat happens next?An acknowledgement text or card will be sent to you, advising youthat we have received your application. An invitation to attend anadvice and guidance interview will then be sent to you.York College reserves the right to refuse admission to a coursewhere it has reasonable grounds for presuming that such an enrolmentwould not be in the best interests of the college.Guidance notes forapplication formIt is important that you read these notes carefully in order to completeyour application form correctly and clearly. Each section providesa step by step guide explaining exactly what information isrequired and how it should be completed. Please complete all sectionsof this form.Before filling in the form it is important that you have consultedthe relevant course information in the York College Course Guideor on the York College website (www.yorkcollege.ac.uk). We recommendthat you discuss your career plans with your family, schooltutors or careers adviser. This will help you to make an informeddecision about your course choice.The application form is the first step to receiving an initial adviceand guidance interview. Whilst it is important to select carefullythe course you wish to apply for, there are many opportunities tochange your choice of course in the light of further guidancethroughout the application procedure.Section 1: Personal DetailsPlease fill in your personal details clearly in block capitals.Your personal email and personal mobile number are important tous as we will be contacting you via text and email with all theup-to-date information on your college application.When filling in your date of birth please give the day, month andthe year as detailed in the following example: 4th July 1992 shouldbe written 04 07 92.Section 2: Emergency ContactPlease fill in details of someone we can contact in the case of anemergency clearly in block capitals.Section 3: Courses Applied ForThis should be completed by students who are applying forfull-time and part-time programmes of study. If you wish to beconsidered for both Apprenticeship/Work-based Learning (WBL)and full-time courses you will need to fill in an additional greenApprenticeship/Work-based Learning Application Form. For furtherinformation and guidance please refer to the York CollegeCourse Guide or call us on 01904 770200.If you are undecided between a few courses, please list them in priorityorder, being careful to write down the course titles exactly asthey are written in the course guide, giving the level of study.Please ensure that you check the qualifications needed for entry ortalk to your careers adviser if you are unsure.Sports Development CentreThe Sports Development Centre is available to talented athletesaged between 16 and 19 years. All those selected will follow afull-time education programme as well as receiving expert coaching.Music Development CentreThe Music Development Centre is suitable for talented musiciansaged between 16 and 19 years who wish to study an A Level or Vocationalqualification in music. All students will be asked to audition.This specialist education with high quality music tuition is forstudents wishing to pursue a career in music or aiming to progresson to a music related course at university.Section 4: How did you find out about your course?Please state, by ticking one or more boxes, how you found informationabout your chosen course(s).Section 5: Education DetailsPlease write down details of your last school or college attendedprior to this application and the town or city in which you studied.Section 6: QualificationsPlease write down the qualification, subject and year of any examsalready taken, or about to be taken if you are still at school. Estimatedgrades should be filled in by your teacher. If you alreadyknow your actual grade please fill in this section yourself.Equality Policy - York College is committed to creating an environmentwhere there is mutual respect and equality of opportunity.Safeguarding Statement - The safeguarding of young people andvulnerable adults is fully embraced by all York College staff and underpinsthe College’s values.Section 7: Employment StatusPlease indicate if you are in paid employment and if your employer/sponsorwill be contributing to your fees. If yes, completeyour employer/sponsor details.All documents can be made available in alternative formats.