Application Form

You are applying for Agriculture Level 2

Course starting

Personal Information

Title *

First name *

Surname *

Legal gender *

Preferred Pronoun *

Date of Birth *

Email Address *

Please note: This email will be used to send you important updates regarding your application, so please double check that this email address is correct, that you can access this email address, and that it is not your school email address

Home Tel. No

Mobile Tel. No *

Please enter your phone number in the format 07777777777

Ethnic Origin *

Address

Address Line 1 *

Address Line 2

Town *

County

Postcode *

Have you been resident in the UK for three years? *

Yes No

Date of entry to the UK

Are you a British Citizen, or an EU/EEA or Swiss national? *

Yes No

Emergency Contact Details

Title *

First name *

Surname *

Email Address *

Home Tel. No *

Mobile Tel. No *

Please enter phone numbers in the format 07777777777

Qualifications & Education

Previous School *

Other, please specify

What is your highest level of education?

In this section please provide as much detail as possible about all the qualifications you hold.

An approximate date will suffice if you do not know the exact date you were awarded you qualification

Type / Level

Subject

Grade

Predicted or Actual Grade?

Predicted Actual

Date

Your Qualifications

Type	Subject	Grade	Date	Remove

Learning Support

Do you have any learning difficulties, disability or health problem? *

Yes No

Disability or Learning Difficulty

Do you have and Education Health and Care Plan? (EHCP) *

Yes No

Are you a young person (under 19 years of age) looked after by your local authority? *

Yes No

Additional Information

How did you find out about SMB College Group? *

Would you like to be contacted about college bus routes?

Yes No

Would you like to be contacted about our on-site accommodation at Brooksby Campus?

Yes No

I understand that the information given on this form can be used for any matter related to my application for a programme of study for the coming or future academic years, and for marketing and research purposes either by the College or by organisations employed by the College to undertake such work. I give my consent to the processing of data on this form on the understanding that the information I have supplied will be used only for the purposes set out above, and my consent is conditional upon the College complying with its obligations and duties in accordance with the College’s registration under the Data Protection Act 1998.

Marketing Consent

Please contact me with news, courses, open days and other information relevant to my interests

Application Form

Personal Information

Address

Emergency Contact Details

Qualifications & Education

Your Qualifications

Learning Support

Additional Information

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