Carshalton College - Enrol Now at Carshalton College

Carshalton College
Tel: 020 8544 4444
Fax: 020 8544 4440
Email: cs@carshalton.ac.uk

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Welcome to Carshalton College

Enrol Now

Course applied for:

Study And Life Preparation (MLD)(SB1001)

Any additional courses:
(Please include the course code which can be found at the bottom of each fact sheet)

Title:

Forename:

Surname:

Date of Birth:

DAY: MONTH: YEAR:

National Insurance Number:

-NI Number part 2 -NI Number part 3 -NI Number part 4 -NI Number part 5

Address:

Postcode:

Daytime Phone No:

Mobile Phone No:

Email Address:

Next Of Kin:

Next Of Kin Phone:

Have you lived in the UK for the last three years?

Yes No

If No please complete the following:-

Country of Birth:

Date of Entry Into The UK:

DAY: MONTH: YEAR:

Country of Domicile:

Have you any disabilities /learning difficulties or supported needs?

Yes No

Nature of disability/Learning difficulties
If you are disabled, please specify any special needs that the college could make provision for, either during the admissions process or during attendance at the college:

Details of present or last School or College:

Dates Attended:

Exams taken or to be taken:

Subject	Type of Qualification i.e. GCSE / A Level	Year Taken / Taking	Grade achieved / expected
1st Subject	1st Qualification Type	1st Qualification Year	1st Qualification Grade
2nd Subject	2nd Qualification Type	2nd Qualification Year	2nd Qualification Grade
3rd Subject	3rd Qualification Type	3rd Qualification Year	3rd Qualification Grade
4th Subject	4th Qualification Type	4th Qualification Year	4th Qualification Grade
5th Subject	5th Qualification Type	5th Qualification Year	5th Qualification Grade
6th Subject	6th Qualification Type	6th Qualification Year	6th Qualification Grade
7th Subject	7th Qualification Type	7th Qualification Year	7th Qualification Grade
8th Subject	8th Qualification Type	8th Qualification Year	8th Qualification Grade
9th Subject	9th Qualification Type	9th Qualification Year	9th Qualification Grade
10th Subject	10th Qualification Type	10th Qualification Year	10th Qualification Grade
11th Subject	11th Qualification Type	11th Qualification Year	11th Qualification Grade
12th Subject	12th Qualification Type	12th Qualification Year	12th Qualification Grade
13th Subject	13th Qualification Type	13th Qualification Year	13th Qualification Grade
14th Subject	14th Qualification Type	14th Qualification Year	14th Qualification Grade

Equal Opportunities Monitoring Form
How would you describe your ethnic origin? (please tick appropriate box) This information will help monitor equal opportunities in the College.

Asian-Asian British–Bangladeshi		Mixed – White & Black African
Asian/Asian British – Indian		Mixed – White & Black Caribbean
Asian/Asian British – Pakistan		Mixed – Any other Mixed background
Asian/Asian British		Mixed – White & Asian
Any other Asian Background		White – British
Black/Black British – African		White – Irish
Black/Black British – Caribbean		White – Any other White Background
Black/Black British		Any Other
Chinese		I would prefer not to state my ethnic origin on this form
Any other black background		I would prefer not to state my ethnic origin on this form

General Information

Have you previously applied or attended a course at this College?

Yes No

How did you hear about Carshalton College?

Are you a Parent?

Yes No

Employment Status

Working Full Time Part Time
Not Working Receiving Benefit

Carshalton College keeps the information provided by enquirers and applicants so that we may be able to let you know, from time to time, about other learning opportunities being provided by the College. If you do not wish to receive such information, please indicate by ticking this box