Adult Course Application Form

RESIDENCY

Nationality*

Ethnicity*

Please select one

Religion/Belief*

Country of domicile*

The country that you consider to be your permanent home

Have you lived in the UK since birth?*

Yes
No

Please provide the date that you entered the UK*

DISABILITIES, MEDICAL CONDITIONS AND LEARNING SUPPORT

Please complete the following section to help us ensure we have the best support in place for you while studying at the college.

Do you have a disability or medical condition?*

Please tick what applies

If yes, please state:

Did you receive extra support when you studied before?*

Do you have an Educational Healthcare Plan (EHCP)?*

Please ensure your local authority formally submits your EHCP to ehcp@brooklands.ac.uk

Do you need any specialist equipment?*

If yes, please state:

OTHER

Do you have a criminal record?*

Reason for this (Child Protection Purposes)

Please state date and details of conviction:*

All criminal convictions will be reviewed prior to any invitation to attend college.

Disclaimer

Brooklands Technical College will undertake all reasonable steps to provide the teaching, examination, assessment and other educational services set out on this website, in its prospectuses and on course leaflets. It does not, however, guarantee the provision of such educational services, programmes and facilities. Brooklands Technical College reserves the right to amend, withdraw, cancel, alter or amalgamate any or part of the programmes, locations, facilities and costs at any time.

Should circumstances beyond the direct control of the college interfere with its ability to provide educational services, programmes and facilities, Brooklands Technical College undertakes to use all reasonable steps to minimise the resultant disruption to those services, programmes and facilities. All courses run subject to enrolment of minimum numbers. Maximum limits may also apply. There are limited places on some courses. Courses may become full before our main enrolment dates, therefore booking early is advised.

I declare to the best of my knowledge that the information I have given is a true and correct record.

I agree with the disclaimers as provided above.*

Yes

Signature of applicant:*

Information provided on this form is held in accordance with the Data Protection Act 1998 and is used for the purpose of student administration and marketing.

Subject and Qualification	Grade Predicted	Grade Obtained	Year