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Full-Time Application Form 2021/22

Please see guidance on completing the application form (page 109 of the Prospectus for School Leavers).
You can apply online at www.strode-college.ac.uk
1. Personal Details
Official first name(s): Official last name:

First name you would like to be known as: Title: Sex: Male Female

Date of birth: / / National Insurance no: Age on 31/08/2021:

Home address: Is this address a temporary address? Yes No

Home phone (inc. code):

Mobile phone:

Postcode: Personal email:

If you are under 19 we will assume you agree to us sharing your data with your parents or guardian/carer, but in the event of any difficulty with this you
should nominate at least one person with whom we can share your data. Does this person live at the same address as you? Yes No
Name: Relationship to you:

Phone number: Email:

2. Residential Status
Nationality: Country of residence (where you have lived for the majority of the last 3 years):

If you have not been resident in the European Economic area (EEA) for the past three years, please give date of entry to EEA:

If you are not from the EEA you will be required to present your passport and visa/pemit at your interview or enrolment.

3. Ethnic Origin Strode College is strongly committed to equal opportunities and we welcome all students regardless of age, gender or ethnic
origin. Please tick the box that describes the ethnic origin with which you most identify yourself.
White Mixed Asian or Asian British Black Other Ethnic Group
English/Welsh/Scottish/ White and Black Caribbean (35) Indian (39) African (44) Other ethnic group -
Northern Irish/British (31) White and Black African (36) Pakistani (40) Caribbean (45) Arab (47)
Irish (32) White and Asian (37) Bangladeshi (41) Other Black/African/ Any other ethnic
Gypsy or Irish Traveller (33) Caribbean background (46) group (98)
Other mixed/multiple ethnic Chinese (42)
Other White background (34) background (38) Other Asian background (43)

4. Additional Support Please tick any of the following which apply to you and indicate with a cross, which ONE is most likely to affect your learning.
I receive assistance/extra time in exams. Please give details:
NO DISABILITY OR LEARNING DIFFICULTY (98) Mental health difficulty (09) Asperger’s Syndrome (15)
Visual impairment (not corrected by glasses) (04) Moderate learning difficulty (10) Temporary disability after illness or accident (16)
Hearing impairment (05) Severe learning difficulty (11) Speech, language and communication needs: (17)
Disability affecting mobility (06) Dyslexia (12) Other physical disability (93)
Profound complex disabilities (07) Dyscalculia (13) Other specific learning difficulty (dyspraxia) (94)
Social and emotional difficulties (08) Autism Spectrum Disorder (14) Other medical conditions (epilepsy, asthma, diabetes) (95)
Other learning difficulty. Please specify: (96)

Other disability. Please specify: (97)

Have you been formally assessed for an identified learning need/disability? Yes No If yes, is the report attached? Yes No

5. Current/Last School or College (under 19s only)

Name of current or last school or college:

Have you had a period of study out of school? Yes No

Please list any qualifications you have, or expect to obtain before you start your course. If English is not your first language, you must indicate which
English language exams you have taken or are to take. *Grade may be predicted or actual.
Subject Level (eg GCSE) Grade* Subject Level (eg GCSE) Grade*

When you come to enrol in August/September 2021, you will need to bring certificates or exam slips to confirm your results.
6. Courses Which study programmes are your interested in? Please list the A Level subjects and/or the vocational course you are interested in.
A Levels: You are advised to take no more than one of the following A Levels, due to the quantity of coursework, deadlines and examination
dates: Fine Art - Craft, Art & Design, Drama & Theatre Studies, Graphic Design and Photography.

Vocational or T Level: Course code:

If you are interested in training as an Apprentice, tell us which professional area you are interested in:
Apprenticeship: Code:

Which is your preferred study programme? A Levels Vocational T Levels Apprenticeship

Please tell us why you have chosen this study programme.

7. About you Please write a few words about your hobbies and interests or part-time job.

Would you like to represent Strode College in competitive sports (if so please state which sport):

8. Eligibility for Vulnerable Bursary Note you will need to provide the evidence to support this before enrolment. Please tick all that apply.
I am a Care Leaver I am a Carer for a member of my family I am looked after by someone other than my parents
I am personally in receipt of Income Support I am in receipt of Employment Support Allowance and Disability Living Allowance

9. Rehabilitation of Offenders
Do you have any criminal convictions except those for minor motoring offences or those spent in accordance with the Rehabilitation of Offenders
Act 1974? Yes No If yes, please specify below:

Please note any criminal convictions except those ‘spent’ under the Rehabilitation of Offenders Act 1974 must be disclosed. Any unspent convictions
can be disclosed above. The details requested are necessary for us to be able to assess your application and will be treated in the strictest of confidence.

10. Data Protection Consent to Process Declaration

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 Strode College processing
this information in accordance with data protection legislation. We will use your personal details to create or verify your Unique Learner Number by
passing your details to the Learning Records Service (LRS). Please see the Prospectus for School Leavers for the full data protection statement.
OPT in to stay in touch. In compliance with the General Data Protection Regulation (GDPR) 2018, if you would like to receive information about our
courses and college activities please select from the following options. Please note, that we will be unable to contact you in the future if you do not
opt in. You can also opt out at any time by contacting the college.
Please tick the following if you wish to receive information: by email by telephone by post by SMS
We always treat your data with the utmost care and Strode College will only share your information with the third parties we are legally obliged to as
indicated in our full privacy statement: www.strode-college.ac.uk/dataprotection
Unique Learner Number. You cannot opt out of having a ULN created. However, you can opt Signature: Date:
in to having achievement information being shared with other institutions and employers, so By emailing this form, you are consenting to
the processing of personal data for any legal
that you will not have to provide such information yourself if requested. I wish to opt in. purpose connected with your studies.

Confidential Reference
All applicants please return this form to us and we will obtain the reference from your school or college. If you are home-schooled please provide
details of your nominated referee below.
Referee Details Please name the individual at your school or college who can be contacted to give further information if required.
Referee’s name (please print):

Address: Postcode:

If you are posting a hard copy of your completed application form, please return it to:
Freepost RTJE-YBZU-BSTB, Strode College, Church Road, STREET, BA16 0AB

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11/08/20 FTApplication.v21.0
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