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Part-Time Application Form

Personal Details

(16 - 18 Students only)

Ethnicity and Residency


Disabilities, Medical Conditions & Learning Support Details

Employment Status

Declaration of Criminal Convictions

As a duty of care to staff and students, the College reserves the right not to enrol a person where there is evidence that they could be a threat or danger to others. Declaring convictions may not prevent you from being offered a place but failure to disclose something of which we later become aware could result in disciplinary action or your enrolment being cancelled.

Course details

Please state which course(s) you wish to enrol on (including course codes if known)

Payment of Fees

Please complete one of the following sections, whichever is relevant to you. If section C applies, evidence must be provided at enrolment to confirm a fee concession


I am satisfied that the costs associated with the programme have been explained to me. If any proposed payment via a loan or employer is not fulfilled, or I withdraw, the liability for any unpaid fees will revert back to me. In the event that a debt collection agency is involved then I will be liable for tuition fees plus any legal and administrative fees incurred. I understand that refunds will only be issued in the event of the course being cancelled by the College or in exceptional circumstances in line with the College Refund Procedure (copy available on request).

Marketing Evaluation

Learning Agreement Declaration

I am satisfied that:

  • The suitability of the programme and the entry requirements for it have been explained to me.
  • I have received information, advice and guidance on my choice of learning programme and progression routes. (not applicable for Adult Community Learning and non-qualification courses)


  • I formally accept the learning programme specified on this agreement.
  • I certify that the information I have provided is complete and correct.
  • I agree to abide by the College regulations and with the Learning Contract (available at or
  • I authorise the College to provide appropriate information to my parent(s) or guardian(s) (if under 19) or employer, sponsor or Student Loan Company (if appropriate) on progress and attendance on courses for which I have enrolled, or in the event of any cause for concern or a medical emergency.
  • I confirm that I have read the Enrolment Terms & Conditions (available at or
  • I agree to be contacted by the College after the end of my course to establish destination data (including Apprenticeship progression) for use within the College reporting mechanisms.

PRIVACY NOTICE 2021/2022 | How We Use Your Personal Information

This privacy notice is issued by the Education and Skills Funding Agency (ESFA) on behalf of the Secretary of State for the Department of Education (DfE) to inform learners about the Individualised Learner Record (ILR) and how their personal information is used in the ILR. Your personal information is used by the DfE to exercise our functions under article 6(1)(e) of the UK GDPR and to meet our statutory responsibilities, including under the Apprenticeships, Skills, Children and Learning Act 2009.

The ILR collects data about learners and learning undertaken. Publicly funded colleges, training organisations, local authorities, and employers (FE providers) must collect and return the data to the ESFA each year under the terms of a funding agreement, contract or grant agreement. It helps ensure that public money distributed through the ESFA is being spent in line with government targets. It is also used for education, training, employment, and well being purposes, including research. We retain ILR learner data for 3 years for operational purposes and 66 years for research purposes. For more information about the ILR and the data collected, please see the ILR specification at

ILR data is shared with third parties where it complies with DfE data sharing procedures and where the law allows it. The DfE and the English European Social Fund (ESF) Managing Authority (or agents acting on their behalf) may contact learners to carry out research and evaluation to inform the effectiveness of training. In these cases, it is part of our statutory duties and we do not need your consent.

For more information about how your personal data is used and your individual rights, please see the DfE Personal Information Charter ( and the ESFA Privacy Notice (


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

Staying in Touch

Your privacy is important to us. We’d like to keep in touch so please complete your contact preferences below.

I confirm that I have read the Learning Agreement Declaration incorporating the Imagery and Staying In Touch sections.

Please click Submit to confirm the above statement.

You can withdraw your permission for the use of your personal data at any time by contacting Client Services. (If you would like a more detailed explanation about GDPR changes and your right to be forgotten visit

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

Main Switchboard: 01737 772611 / Client Services: 01737 788444 / Email:

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