Student Number:
(Office use only)
Full Time Application Form
Which campus are you applying for? Your Unique Learner Number:
ASHFORD CAMPUS
WEYBRIDGE CAMPUS
PERSONAL DETAILS
Title: Mr Miss Ms Mrs (please tick)
First Name: Home Telephone Number:
Surname: Mobile Number:
Address: Email:
Name of Parent/Guardian:
Postcode: (if student is under 18)
Date of Birth: Contact Telephone Number of Parent/
Age: Guardian:
COURSE YOU ARE APPLYING FOR
What course(s) you are interested in:
Unsure of which course to take?
Tick here if you would like to request a guidance discussion:
Career Ambition (if known):
Are there any specific dates when you would be unable to attend an interview?
WHERE DID YOU HEAR ABOUT BROOKLANDS COLLEGE?
Internet Friends/Family School
Newspaper Advert Word of mouth Connexions
Radio Leaflet Other
If other please specify:
In the past have you taken part in any activities/events organised by Aim Higher?
Yes No
SCHOOL/COLLEGE DETAILS
Are you currently a full time student at Brooklands College? (if yes please tick)
Are you currently in Year 10 or Year 11 (please tick one if relevant)
We will write to your school to request a reference.
Name and Address of most recently attended School/College:
Leaving Date:
Exams to be taken or already obtained:
Subject Grade Predicted Grade Obtained Year
EQUAL OPPORTUNITIES MONITORING
Please tick one:
11 Asian or Asian British - Bangladeshi 19 Mixed - White and Asian
12 Asian or Asian British - Indian 20 Mixed - White and Black African
13 Asian or Asian British - Pakistani 21 Mixed - White and Black Caribbean
14 Asian or Asian British - any other 22 Mixed - Any other Mixed background
Asian background
23 White - British
15 Black or Black British - African
24 White - Irish
16 Black or Black British - Caribbean
25 White - any other White background
17 Black or Black British - any other
98 any other
Black background
99 not known/not provided
18 Chinese
LOOKED AFTER CHILDREN QUESTION
Are you in the care of the Local Authority Yes No
or Leaving Care Team?
RESIDENCY
Nationality: Time Living in the UK:
Country where you normally live: Date of entry to UK if within the last 3 years:
/ /
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? Yes No
If yes please circle below:
01 visual impairment 08 temporary disability after illness or accident
02 hearing impairment 09 profound complex disabilities
03 disability affecting mobility 10 aspergers syndrome
04 other physical disability 90 multiple disabilities
05 other medical condition 97 other
(e.g epilepsy, asthma, diabetes)
98 no disability
06 emotional/behavioural difficulties
07 mental health difficulties
Do you think you have a learning difficulty? Yes No
If yes please circle below:
01 moderate learning difficulty 20 autistic spectrum disorder
02 severe learning difficulty 90 multiple learning difficulties
10 dyslexia 97 other
11 dyscalculia 98 no learning difficulty
19 other specific learning difficulty
Did you receive extra support when you studied before? Yes No
Did/Do you have a statement of Special Educational Need? Yes No
Do you need any specialist equipment? Yes No
Please tick relevant circles if you feel you will need extra support in any of the following to
successfully complete your course.
Maths Spelling English as a foreign language
Study Skills Writing Other
Reading
OTHER
Do you have a criminal record? Yes No
Reason for this (Child Protection Purposes):
I declare to the best of my knowledge that the information I have given is a true and
correct record.
Signature of Applicant: Date:
Information provided on this form is held in accordance with the Data Protection Act 1998
and is used for the purpose of student administration.
Please return your application form to:
Brooklands College - Weybridge Campus - Heath Road, Weybridge, KT13 8TT
Thank you for your application. We will write to you promptly to acknowledge receipt of
your application. If you don’t hear anything after 2 weeks please contact us.
01932 797 797
[email protected] www.brooklands.ac.uk
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