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Full-Time Application Form

Personal Details

Title*
Dr
Mr
Mrs
Miss
Ms
Mx
First Name(s)*
Surname*
Current Address*
Postcode*
Home Tel Number
Mobile Tel Number*
Email Address*
Gender*
Date of Birth*
Age on 31/08/19*
National Insurance Number

Safeguarding Information


First Next of Kin/Carer

Next of Kin/Carer Name*
Next of Kin/Carer Tel Number*
Next of Kin/Carer Email Address

Second Next of Kin/Carer

Next of Kin/Carer Name*
Next of Kin/Carer Tel Number*
Next of Kin/Carer Email Address
Are you currently or have you recently been in foster care or in care of the local authority?*
Yes
No
Are you a registered young carer?
Yes
No
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Ethnicity Details

Please tick one box which best describes your ethnic origin: (The College requires this information to monitor Applications with regard to its Equal Opportunities Policy)*
English/Welsh/Scottish/Northern Irish/British
Irish
Gypsy or Irish Traveller
Any Other White Background
White and Black Caribbean
White and Black African
White and Asian
Any Other Mixed/Multiple Ethnic Background
Indian
Pakistani
Bangladeshi
Chinese
Any Other Asian Background
African
Caribbean
Any Other Black/African/Caribbean Background
Arab
Any Other Ethnic Group
Do not wish to declare
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Residency

Nationality*
Have you lived in the UK for the last 3 years?*
Yes
No
Please enter date of entry into the UK
Please state which country you lived in previously
Have you come to this country with the purpose of taking full-time education?
Yes
No
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Disabilities, Medical Conditions & Learning Support

Do you have a learning difficulty and need support with your learning?*
Yes
No
Please tick below which applies to you
Autism Spectrum Condition (14)
Dyscalculia (13)
Dyslexia (12)
Mild/Moderate Learning Difficulty (10)
Severe Learning Difficulty (11)
Speech, Language & Communication Needs (17)
Other Specific Learning Difficulty (94)​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​
Do you have an Education Health & Care Plan (EHCP)?*
Yes
No
Do you have a disability or medical condition?*
Yes
No
Prefer not to say (98)
Please tick below which applies to you
ADD/ADHD (95)
Aspergers Syndrome (15)
Asthma (95)
Diabetes (95)
Disability Affecting Mobility (06)
Epilepsy (95)
Hearing Impairment (05)
Mental Health Difficulty (09)
Other Physical Disability (93)
Profound Complex Disabilities (07)
Social & Emotional Difficulties (08)
Temporary Disability After Illness or Accident (16)
Visual Impairment (04)
Wheelchair User (06)
Other (97) - Please provide details
Please specify the severity of your condition or state the main condition if you have ticked more than one box
Do you think you require support or adaptations in College?
Yes
No
Please specify any prescribed medication you are taking
Please list any allergies relevant to your proposed course
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Course Details

Please state which course(s) you wish to study as indicated in the course guide:

First preference
Second preference
Please tick here if you are unsure about which course to choose and if you would like an Information, Advice and Guidance Interview prior to application
What are your career or higher education aims? (if known)
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Education

Have you attended East Surrey College before?
Yes
No
Which course did you take?
Name of present or last school or college?
From (mm yyyy)
To (mm yyyy)
Previous studies: Examinations taken or to be taken - if none, please write NONE. Please include subject and Level (BTEC/GCSE/AS/A Level or other qualification)
Grade Passed/Predicted
Year of Examination
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Reference

Please provide the name and address of someone who could give you a reference. If you are at school or have left this year, this could be your Head Teacher or Head of Year/House. If you have a recent pupil reference from your school a copy of this will be required. If you are a mature student, please provide the name and address of a personal or work referee.

Title*
First Name*
Surname*
Address*
Postcode*
Daytime Tel Number*
Email Address*
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Other Details

Do you have any unspent criminal convictions? (If you tick 'Yes' you will be contacted by a member of our Advice and Guidance team for further information. A criminal conviction may prevent you from enrolling on certain courses)*
Yes
No

Marketing Evaluation

Are you a current East Surrey College student?*
Yes
No
Where have you seen marketing promotions for your course/ESC? (Please tick all that apply)*
Billboard
Bus Stop Tram Advert
College Open Event
Course Guide
Email
Employer
Facebook/Instagram
Family/Friend
Former/Current Student
Hotcourses/Floodlight
Job Centre Plus
Leaflet
LinkedIn
Press Advert
School/College
Search Engine (eg Google)
Text Message
Twitter
Website
Other:(please state)
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Staying in Touch

Your privacy is important to us. We'd like to keep in touch so please complete your contact preferences. Please select below to make sure you don't miss out!

I would be interested in receiving (Please tick all that apply)*:
Information about new courses
Newsletters and details on upcoming events
Research and surveys
None of the above
I am happy for the College to contact me by (Please tick all that apply):
Email
Post
Telephone
SMS (Text)

You can withdraw your permission for the use of your personal data at any time by emailing: clientservices@esc.ac.uk. If you would like a more detailed explanation about GDPR changes and your right to be forgotten, visit: www.ico.org.uk

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Imagery

On occasion you may be photographed/filmed in your classroom, around the College or at an event. Your image and your name may be used to celebrate student success or to promote courses and events.

I give my permission for East Surrey College to publish my image and/or name in any printed and/or electronic promotional materials. The College will not utilise my personal data in a defamatory manner and shall keep it secure throughout the period of its use. I understand that I can withdraw my permission at any time although I am aware any such published material will not be recalled if I choose to withdraw my consent.*
Yes
No
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Your Application

I declare that to the best of my knowledge the information I have given is a true and correct record and I give my consent to East Surrey College processing this information in accordance with GDPR and the Data Protection Act 2018.

I understand that some of the information requested will be stored and may be made available to the Education and Skills Funding Agency (ESFA), on behalf of the Secretary of State for the Department of Education (DfE). For the purposes of the Data Protection Act 2018, the DfE is the data controller for personal data processed by the ESFA. Your personal information is used by the DfE to exercise its functions and to meet its statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009 and to create and maintain a unique learner number (ULN).

Please Confirm Your Application

You can withdraw your permission for the use of your personal data at any time by contacting Client Services at clientservices@esc.ac.uk (If you would like a more detailed explanation about changes to General Data Protection Regulations and the right to be forgotten visit https://ico.org.uk)

I apply for admission as a Student to East Surrey College*
I am aged 16+ and confirm I understand the questions I have answered above.
I am aged under 16 and understand that I will need a parent/guardian to confirm the details above (Please provide their contact name/email address below).
Name of parent/guardian:
Email address of parent/guardian:

Services delivered are financed in whole or part by the European Social Fund.

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Address: East Surrey College, Gatton Point, London Road, Redhill, Surrey RH1 2JX

Main Switchboard: 01737 772611 / Client Services: 01737 788444 / Email: clientservices@esc.ac.uk

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