Tresham

• Title (Mr/Mrs/Miss/Ms/other)*
• Surname*
• Forename(s)*
• Date of birth*
• Gender* Male Female
• Email address*
  Must be a valid email address.

• House No/Name*
• Street*
• Town*
• County*
• Postcode*
• Contact Number*

• Are you an existing learner at Tresham? Yes:   No:
• If Yes please state Learner ID number
• Have you lived in the UK/EEA for the last three years?* Yes No
• Nationality*

If applying for A levels, please state "A levels". You don’t need to specify subjects.

• Course Title*
• Course Code*
• Campus*
• To start in Month:* January February March April May June July August September October November December   Year:* 2013 2014 2015 2016 2017 2018

• Name of school/college attending/attended
• School dates From: (year)   To: (year)
• Qualifications gained or to be taken (for qualifications to be taken please state predicted grades).
  Subject, Level and Grade fields are mandatory for the first line. Actual / predicted grade is mandatory for each qualification entered.
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  
  • Subject:         Level:
    Grade: A* A B C D E F G U pass merit Distinction      Actual/ predicted grade: actual predicted
    Date:   Exam board:  

• Do you have a learning difficulty, disability, sensory impairment or medical condition? Yes:   No:
• If yes, please state
• Do you have a statement of special education need? Yes:   No:
• If yes, please state
• Do you feel that you will need extra support in your studies for any other reason? Yes:   No:
• If yes, please state

We are committed to equality and diversity. To help us monitor our policy please complete the following.

• Ethnic Origin* White English/Welsh/Scottish/N Irish/British White Irish White Gypsy or Irish Traveller Any other White background Mixed White & Black Caribbean Mixed White & Black African Mixed White & Asian Any other Mixed/Multiple Ethnic background Indian Pakistani Bangladeshi Chinese Any other Asian background Black African Black Caribbean Any other Black/African/Caribbean background Arab Any other ethnic group

Failure to disclose criminal offences could lead to either your application being rejected, or if you are enrolled, withdrawal from your course

• Do you have a Police record for any conviction, caution, bind over order or warning? Yes:   No:
• If yes, please state
• Do you have any prosecutions or offences pending? Yes:   No:

• Name of Parent/Guardian (If applicant is under 18)
• I certify that the information I have provided is correct to the best of my knowledge. I understand that completion of this form does not automatically guarantee me a place on the course and that the college reserves the right to amend course details as published.
  Terms & Conditions / Data Protection

• How did you hear about your chosen course?
  • Prospectus
  • Website
  • Existing Tresham Student
  • Parents/Friends
  • Careers Advisor
  • Newspaper
  • Open Evening
  • Job Centre
• If other, please state