School Leavers - Learning opportunities for the 16 to 19 age range

Online Application Form

Use the form below to apply for a course at Stourbridge College.

Please do not submit more than one application. If, after you apply, you wish to make any changes or apply for an alternative course, please telephone the Admissions Team on 01384 344634.

The * symbol denotes a required field.

Personal details

*Forename(s):

*Surname:

*Title:

*Gender:

Male Female

*Date of Birth:

*Address:

*Post Code:

*email address:

Home Telephone:

Mobile Telephone:

*Country of Birth:

*Ethnic Origin
(This information is required for statistical purposes only).

What language do you speak at home?

If an overseas student give date of entry to the UK:

*Parent/Guardian Name &
Contact Details :

Preferred courses

Not sure what to do at college?
Please tick the box for an informal chat with one of our advice staff:

A Levels (maximum of 4)

Full-Time Vocational:

Apprenticeship:

Do you have an Employer relevant to the Apprenticeship
Programme you are applying for? Yes No

Education

*Present school or college:

If your school or college is not listed above, type its name and
town in this box:

*Dates attended:

from: to:

Examinations to be taken or already taken.

Subject	Type of Examination	Year taken or to be taken	Actual or Predicted grade
Subject 1	Type 1	Year 1	Grade 1
Subject 2	Type 2	Year 2	Grade 2
Subject 3	Type 3	Year 3	Grade 3
Subject 4	Type 4	Year 4	Grade 4
Subject 5	Type 5	Year 5	Grade 5
Subject 6	Type 6	Year 6	Grade 6
Subject 7	Type 7	Year 7	Grade 7
Subject 8	Type 8	Year 8	Grade 8
Subject 9	Type 9	Year 9	Grade 9
Subject 10	Type 10	Year 10	Grade 10

Use the box below to list any other qualifications.

Careers Advice

Careers

*Have you received a careers interview at school ?

Yes No

What career would you like to follow?

If you have a Connexions PA...

What is the name of your Connexions PA?

Your Connexion PA's telephone number:

Additional Support

Learner Support

Would you describe yourself as
having a disability or learning difficulty? Yes No

If yes, please state your disability or learning difficulty.

Do you require any assistance when you attend for
an interview? (i.e. interpreter/wheelchair access/signer) Yes No

Reference

Reference - Required only if you are NOT a school leaver

If you are not a school leaver, please give the details of someone willing to provide a reference (not a friend or a relative). By giving us this information, you consent to us contacting your referee.

Use the box below to enter you referee's
name, address, email address and telephone number.

Personal Statement

Please use this space to tell us about yourself. Include hobbies/interests/work experience and future career path.

Finish

Please ensure that you have completed this application form correctly.

All information provided on this form will be processed in accordance with data protection legislation. The information provided will be used by the College to administer the application.

Click on the 'Submit' button below to send this application to us.

School Leavers

I'm really enjoying my course. I find the tutors helpful and encouraging and they have helped me to develop my skills and become more confident with my ideas.