Unit 16-19 Application Form
16-19 Application Form
Hand in to Customer Services or send to Central Admissions Jennens Road, Birmingham B4 7PS e.admissions@bmetc.ac.uk w.www.bmetc.ac.uk t.0845 155 0101
Personal Information
Ref No.
Title (Mr. Mrs. Ms. Miss)
Forenames
Date of Birth
Age
Surname
Male
Female
Address
Post Code
Email
Mobile
Telephone
National Insurance Number
Unique Learner Number
How would you describe your ethnic origin
White
Mixed/Multiple
Asian/Asian British
Black/African/Caribbean/Black British
English/Welsh/Scottish/
White and Black Caribbean
Indian
African
Northern Irish/British
White and Black African
Pakistani
Caribbean
Irish
White and Asian
Bangladeshi
Any other Black/African/Caribbean
Gypsy or Irish Traveller
Any other mixed/multiple
Chinese
background
Any other White background ethnic background
Any other Asian background
Other
Arab Any other ethnic group
Residency Status
Have you been a resident in the UK for the last 3 years?
Yes
No
Are you an Asylum Seeker/Refugee?
Yes
No
Do you hold or require a Study Visa
Yes
No
Do you hold or require any other Visa
Yes
No
If no please provide date of entry
Visa Type
Visa Expiry Date
Equal Opportunities
Do you consider yourself to have a disability, learning difficulty and/or health problem?
Yes
If Yes please provide details
The College can provide additional support during your study eg. numeracy, literacy and dyslexia support.
Would you like to access these services?
Yes
No
If Yes please provide details of the support required.
Do you have a Learner Support Plan?
Yes
No
Yes
No
If yes please provide a copy with your application.
Do you require any specific arrangements for you at interview?
If Yes please provide details.
No
Course Information enter the courses or subjects you are applying for
Intermediate Vocational (Level 2)
A2 level
Foundation Vocational (Entry/Level 1)
AS level
Advanced Vocational (Level 3)
Other (please specify)
Please indicate subject(s)
Yes
Are you planning on studying with any other training provider whilst you are studying at BMET?
No
If Yes please provide details please tick preferred campus (check the course you are applying for is offered at that campus)
Sutton Coldfield Campus
Matthew Boulton Campus
James Watt Campus
Erdington Skills Centre
Castle Vale Skills Centre
Language Centre
Employer Information current or last employer
Name of employer
Contact name for reference Title
Address
Post Code
Email
Telephone
Qualifications you are currently taking or have already completed
Subject
Type/Level
GCSE, BTEC etc
Date Achieved
Year
Grades
Achieved
/Predicted
Type/Level
Subject
GCSE, BTEC etc
Date Achieved
Year
Grades
Achieved
/Predicted
Interests/Activities & Future Plans
Please give brief details of responsibilities taken at school/work and any outside interests/activities
What are your ambitions for future education and career goals?
How did you find out about the College please tick all applicable
School
Employer
Careers Advisor
Job Centre
Cinema
Capital Radio
Free Radio
Kerrang Radio
Newspaper/Magazine
Leaflet/Flyer/Poster
Web Site
NAS website
Friend/Family
Current/former student
Facebook/Twitter
Other please specify
Your Signature
I declare that I have checked the information given in this form and that to the best of my knowledge it is correct. I consent to this information being held on file under the terms of the Data Protection Act 1988. I agree to abide by the College regulations and understand that the information I have provided may be shared with other partner organisations for the purposes relating to education or training.
Applicant’s Signature
Date
Hand in to Customer Services or send to Central Admissions Jennens Road, Birmingham B4 7PS e.admissions@bmetc.ac.uk w.www.bmetc.ac.uk t.0845 155 0101
Personal Information
Ref No.
Title (Mr. Mrs. Ms. Miss)
Forenames
Date of Birth
Age
Surname
Male
Female
Address
Post Code
Mobile
Telephone
National Insurance Number
Unique Learner Number
How would you describe your ethnic origin
White
Mixed/Multiple
Asian/Asian British
Black/African/Caribbean/Black British
English/Welsh/Scottish/
White and Black Caribbean
Indian
African
Northern Irish/British
White and Black African
Pakistani
Caribbean
Irish
White and Asian
Bangladeshi
Any other Black/African/Caribbean
Gypsy or Irish Traveller
Any other mixed/multiple
Chinese
background
Any other White background ethnic background
Any other Asian background
Other
Arab Any other ethnic group
Residency Status
Have you been a resident in the UK for the last 3 years?
Yes
No
Are you an Asylum Seeker/Refugee?
Yes
No
Do you hold or require a Study Visa
Yes
No
Do you hold or require any other Visa
Yes
No
If no please provide date of entry
Visa Type
Visa Expiry Date
Equal Opportunities
Do you consider yourself to have a disability, learning difficulty and/or health problem?
Yes
If Yes please provide details
The College can provide additional support during your study eg. numeracy, literacy and dyslexia support.
Would you like to access these services?
Yes
No
If Yes please provide details of the support required.
Do you have a Learner Support Plan?
Yes
No
Yes
No
If yes please provide a copy with your application.
Do you require any specific arrangements for you at interview?
If Yes please provide details.
No
Course Information enter the courses or subjects you are applying for
Intermediate Vocational (Level 2)
A2 level
Foundation Vocational (Entry/Level 1)
AS level
Advanced Vocational (Level 3)
Other (please specify)
Please indicate subject(s)
Yes
Are you planning on studying with any other training provider whilst you are studying at BMET?
No
If Yes please provide details please tick preferred campus (check the course you are applying for is offered at that campus)
Sutton Coldfield Campus
Matthew Boulton Campus
James Watt Campus
Erdington Skills Centre
Castle Vale Skills Centre
Language Centre
Employer Information current or last employer
Name of employer
Contact name for reference Title
Address
Post Code
Telephone
Qualifications you are currently taking or have already completed
Subject
Type/Level
GCSE, BTEC etc
Date Achieved
Year
Grades
Achieved
/Predicted
Type/Level
Subject
GCSE, BTEC etc
Date Achieved
Year
Grades
Achieved
/Predicted
Interests/Activities & Future Plans
Please give brief details of responsibilities taken at school/work and any outside interests/activities
What are your ambitions for future education and career goals?
How did you find out about the College please tick all applicable
School
Employer
Careers Advisor
Job Centre
Cinema
Capital Radio
Free Radio
Kerrang Radio
Newspaper/Magazine
Leaflet/Flyer/Poster
Web Site
NAS website
Friend/Family
Current/former student
Facebook/Twitter
Other please specify
Your Signature
I declare that I have checked the information given in this form and that to the best of my knowledge it is correct. I consent to this information being held on file under the terms of the Data Protection Act 1988. I agree to abide by the College regulations and understand that the information I have provided may be shared with other partner organisations for the purposes relating to education or training.
Applicant’s Signature
Date