Access Aplication Form - Stockton Riverside College
Access Aplication Form - Stockton Riverside College
Access Aplication Form - Stockton Riverside College
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Reference No: B Date received:<br />
National Insurance No:<br />
PLEASE RETURN TO (NO STAMP REQUIRED)<br />
Information & Guidance<br />
<strong>Stockton</strong> <strong>Riverside</strong> <strong>College</strong><br />
FREEPOST NEA 14509<br />
Harvard Avenue, Thornaby,<br />
<strong>Stockton</strong> on Tees, TS17 6BR<br />
Tel: (01642) 865566<br />
PART-TIME APPLICATION FORM ~ ACCESS COURSES<br />
Please tick the box(es) which relate to the study area you are interested in. (You may tick more than one)<br />
Health Studies<br />
Art & Design<br />
Humanities & Social Science<br />
Counselling<br />
I prefer to do this course on a Day Evening<br />
Surname<br />
Address:<br />
First name(s)<br />
Title (please tick) Mr Mrs Miss Ms<br />
Date of birth<br />
Email<br />
Daytime phone no.<br />
Postcode:<br />
Mobile number<br />
Evening phone no.<br />
NB: Please remember to inform the college of your new address or your new telephone number if circumstances change. We<br />
may contact you via your email address and / or mobile phone to progress your application, or provide further information on<br />
course / learning opportunities. Please tick the box if you do NOT wish us to contact you in this way <br />
If you consider yourself to have any of the<br />
following, and may require support on your<br />
course, please tick the appropriate box(es)<br />
below:<br />
Blind / partially sighted (excluding<br />
glasses)<br />
Hearing loss<br />
Physical impairment<br />
Diabetes<br />
Epilepsy<br />
Specific learning difficulty<br />
Learning difficulty<br />
Wheelchair user<br />
Asthma<br />
Other<br />
Nationality<br />
Have you been resident in the UK or EU for<br />
all of the last three years?<br />
Yes<br />
No<br />
Please could you indicate where you heard<br />
about the college:<br />
Newspaper Advert<br />
Poster<br />
School<br />
Direct enquiry to the college<br />
Careers Service<br />
Radio<br />
Other, please specify<br />
Please give brief details so that we can<br />
help you from the start of your course:
What kind of employment or future study are you interested in after completing your <strong>Access</strong><br />
Course? (if known)<br />
Have you received any careers guidance prior to applying for this course?<br />
Yes (please state where you received this guidance)<br />
No<br />
Please give details of any academic qualifications you hold and dates gained (please note that<br />
no qualifications are needed to enter the course)<br />
Subject Grade Subject Grade<br />
Please give brief details of any activities you have been involved in since leaving full-time<br />
education (e.g. employment, voluntary work, family raising, other interests)<br />
Data Protection<br />
The college has a Code of Practice on Disclosure (which is available on our website www.stockton.ac.uk).<br />
Applicants to some programmes will be subject to a disclosure check and as such the college has a policy<br />
statement on the recruitment of ex-offenders (available from Information & Guidance).<br />
Having a criminal record will not necessarily debar you from becoming a student at the college. This<br />
will depend on the nature of the programme and the nature and background of your offence. The college reserves<br />
the right to refuse admission to anyone who could put the college’s staff, students and visitors at risk.<br />
Student signature:<br />
Date:<br />
Please forward your completed application form to IandG@stockton.ac.uk
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