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Front Street
Consett
Co. Durham
DH8 5EE
Tel: (01207) 585900
Fax: (01207) 585991
 
Email: enquiries@derwentside.ac.uk

Online Full-Time Application Form

About You (Please complete in black ink and capitals)

Surname: * Date of Birth: *
First Names: * Home Telephone No:
Address: * Mobile Phone No:
Unique Learner Number:
Name of Parent/Guardian:
(if you are under 18)
Sex: * Male  or Female
Postcode: *
E-mail: * National Insurance No:

Education and Qualifications

Schools, Colleges, Other Providers attended (pre and post 16):
School/College Date From: Date To:
     
Have you attended Derwentside College before? Yes No
     
Qualification
(e.g. GCSE)		 Subject Exam Date
(e.g. June 2007)		 Result / Predicted Grade

What course would you like to do?

Course / Training Pathway / Subject
 
Have you received advice and guidance about your choice of course? Yesor No
Was this from: Careers AdviserCareers Teacher Derwentside College Adviser
Other(please state)

Referee:
(Please give us details of one referee. This should be a person, excluding relatives, who can comment on your abilities)

Referee Name:
Organisation:
Address:
Postcode: Telephone Number:
E-mail Address:

Do you consider yourself to have a learning difficulty or disability?

No Yes Please give brief details:

Did you receive support at previous school/college?

No Yes Please give brief details:

Data Protection Statement
 Information from this form will be stored on computer and may be used in accordance with the provisions of the Data Protection Act 1998.

Signed:
   
Today's Date:

Where did you hear about Derwentside College?

School Friend/Relative Other Please state:
College Advert College Open Events Connexions Adviser Internet

All fields marked with an asterisk (*) must be completed

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