Surname	Forename

Address

Postcode Mobile Email

Gender Date of Birth

Male
Female

Gender		Date of Birth
Male Female

Daytime Contact Telephone Daytime Contact Person

SECTION A - Courses

Seevic Campus

Choose the course you would like to study below. If you are choosing AS Levels please select four

NCB Campus

Choose the course you would like to study below. If you are choosing AS Levels please select four

SECTION B - Essential Skills

If you wish to apply for the Essential Skills programme for students with learning difficulties and/or disabilities please check below

I would like to apply to Essential Skills

SECTION C - Soccer Coaching Open

If you wish to apply for SCORE in addition to your chosen course please check below

I would like to apply for SCORE

Name and Address of Present School or College Attended

Qualifications

Please enter below any examinations already taken with the grade achieved or for which you are awaiting results.
Also list current qualifications you are studying e.g. GCSEs, AS Levels, BTECs etc.

Year Taken	Subject	Level	Grade (if known)

Other Information

Do you have any additional support needs? If yes please specify.
Yes No
Are you part of the gifted and talented programme at school? If yes please specify.
Yes No

Activities and Interests

Please give details of any activities that you are involved in or interests that you have.

Possible Career

If you have any ideas about a future career at this stage, please give some details below.

How did you get to know about Seevic College and NCB? Select appropriate box(es)

Family/Friends
College/School
Local Library
Newspaper

Careers Service
Radio
Cinema
Website

Other (please specify)

How did you get to know about Seevic College and NCB? Select appropriate box(es)
Family/Friends	College/School	Local Library	Newspaper
Careers Service	Radio	Cinema	Website
Other (please specify)

Where did you get/see the Seevic College and NCB Prospectus? Select appropriate box(es)

Seevic College
Local Library
Careers Service
School

Website
Other (please specify)

Where did you get/see the Seevic College and NCB Prospectus? Select appropriate box(es)
Seevic College	Local Library	Careers Service	School
Website	Other (please specify)

Please give any other details about yourself that you think may be of use to us.

Have you been legally resident in the UK/European Union for the last three years?
If No, please refer to page 11 of the prospectus

Yes
No

Do you have a criminal conviction, formal conviction, reprimand or final warning from the Police?
This will be discussed at your interview.

Yes
No

Have you been legally resident in the UK/European Union for the last three years? If No, please refer to page 11 of the prospectus
Yes No
Do you have a criminal conviction, formal conviction, reprimand or final warning from the Police? This will be discussed at your interview.
Yes No

By submitting this form I certify that the information I have given on this form is correct and I give my consent to the processing and sharing of this information for all purposes relating to my application*.

*Data on your proposed course will be held on computer and used to analyse applications and support curriculum planning.