Application Form for a course at Salford City College

* Field must be completed.

The College offers help and guidance if you are unsure which course or career to choose.
If you want this help, tick this box

Personal Details

Title (Mr, Mrs, Miss, Other) *
Forename(s) *
Surname *
Gender Male Female *
Date of Birth *
Address *
Town/City *
County
Country
Postcode
Telephone *
Mobile No
Email Address

If you have a special need or disability which we may be able to help you with, please tick this box.


(A declaration here will only be passed on to Student Services who will contact you to discuss your needs.)

Have you been resident in the UK for the past 3 years?Yes No*


If you are under 19, please give the details of the school that you have previously attended. If you are over 19, you may leave this section blank

The name of your school/the school that you most recently attended
Date of leaving
The name of your parent/guardian


Course Details

Name of the course for which you are applying. *

If you do not have a specific course in mind, please enter the area of learning that you are interested in.

If you have attended a College (including Salford College), please give the name of the College

College Name

From    

 to  

Please select which college centre you would most like to attend:

Preference 1:
Preference 2:
Preference 3:

How did you find out about the College? (Please tick all appropriate boxes)

College Open Day
Careers Officer
College Prospectus
Press Adverts
School/College Link Tutor
Family
Friends
Other (please specify)


Examinations obtained, awaiting results, or to be taken.


Subject Level Result Year


Further information

Please give any further information which you feel will support your application. You might like to include any voluntary work, spare time hobbies, interests, sports or work experience.


Referee

Please give the name and address of a person who could provide a reference telling us about your suitability for the course. Normally this will be your present Head Teacher or Course Tutor.

Referee
Name
Position
Address


Postcode
Tel Number


Equal Opportunities

Salford College is working towards equal opportunities and to help the College monitor the effectiveness of its equal opportunities policy, we would be grateful if you would answer the questions listed.

Ethnic Origin*
Asian/Asian British-Bangladeshi
Asian/Asian British-Indian
Asian/Asian British-Pakistani
Asian/Asian British-Other Asian Background
Black/Black British-African
Black/Black British-Caribbean
Black/Black British-Other Black Background
Chinese
Mixed-White & Asian
Mixed-White & Black African
Mixed-White & Black Caribbean
Mixed-Other Mixed Background
White-British
White-Irish
White-Other Background
Other
Not Known

 


If you have any problems or questions about this application form, please contact us on 0161 211 5001/2/3.