The Centre of Excellence for Media & Communications and Combined Studies

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Application Form

Application form in PDF
Application form in DOC

Course Title    
2nd Choice    
Title: Mr Mrs Miss Dr    
First Name    
Date of Birth Age  
Email Address Mobile Number
Home Telephone Work Telephone

How did you hear about the course?
Returning Learner School Careers Service Friend Prospectus Newspaper
Website Radio Cinema Bus Poster
Other (Please state)
Learning Needs
Will you need support for any particular learning requirements whilst you are on your course? Yes No
Blind/Visual Impairment Deaf/Hearing Impairment Speech Difficulties Wheelchair use
Other mobility needs Dyslexia Mental Health ADHD
Other (Please state)
Your Citizen status
What is your nationality?
Have you been living continuously in the UK or EU as a citizen since 1st Jan 2005? Yes No        
If you have lived somewhere else please write the name of your country of ordinary residence?
Do you have permanent leave to remain in the UK/EU? Yes No
Are you an asylum seeker? Yes No Are you subject to visa restrictions? Yes No
Is English your first language? Yes No If No, please specify


Your Qualifications

Your current/last secondary school (under 19's only)
Other than school, have you attended an educational establishment in the past academic year? Yes No
Higher Education Adult Education Further Education College Other
Please state the qualifications you have acheived in the past 5 years (or will be taking this summer)
Subject Level Date Grade   Subject Level Date Grade
What was you highest national qualification prior to this enrolment?
Entry Level (Skills for Life) Other qualifications below Level 1 Level 1 (GCSE's E-G)
Level 2 (Five GCSE's A*-C, Foundation, NVQ) Level 3 (Min 4 AS/1xA2 + GCSE A*-C, BTEC National)
Level 4 (Foundation Degree, HND, Professional Qualifications) Level 5 (Degree)


Work Experience / Employment

Please give details of any work experience or employment that is relevant to your course.

Thank you for completing this Application Form. We will contact you in due course to arrange an interview with your Course Tutor (if necessary), and you may also be asked to take a short aptitude test. All the information on this form will be held subject to the terms of the Data Protection Statement, and will only be passed to Government Departments and Agencies for statistical record purposes. All data is held in accordance with the Data Protection Act.
You must fill in the following two boxes otherwise we can not process the form.


I declare all the information on this form is correct Date
IMPORTANT - Please check that you have filled out the information in this form correctly as, once you click the button below, the information will be sent directly to our Guidance & Admissions department for processing.


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registered in England (Reg. No. 1086634 )