BSix



	Address: BSix Brooke House Sixth Form College Kenninghall Road London E5 8BP Freephone: 0800 3892 947 Email us

Personal Details
Surname/family name:
First name(s):
Gender:	male female
Date of birth (dd/mm/yyyy):

Address:
Postcode:
Telephone:
Mobile:
Email:
Residential status Have you been living in the UK or EU for the last three years?	yes no

Have you attended this college before?	yes no
If yes, which course and year?	Not Applicable


Students needing extra help/support Do you have a learning difficulty or disability	yes no
if yes please provide details:	Not Applicable
Do you require any support at interview?:	yes no
if yes please provide details:	Not Applicable
Are there any other things we need to know about you? (eg medical condition):	yes no
if yes please provide details:	Not Applicable

Ethnic origin:

Referee's details:
Teachers name:
Last School/college:
When did you finish?(mm/yy):
Address:
Postcode:
Telephone:

Qualifications (expected of actual):
	Subject	Level (eg GCSE)	Expected Grade	Actual Grade
Subject 1:
Subject 2:
Subject 3:
Subject 4:
Subject 5:
Subject 6:
Subject 7:
Subject 8:
Subject 9:
Subject 10:

Course/Subject details What courses or subjects do you wish to apply for? Course/Subject names:

1.
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How did you hear about BSix Sixth Form College?

	Connexions Internet Prospectus/Leaflet School Word of mouth Other (please specify below)



	I agree to BSix Brooke House Sixth Form College collecting and processing personal data contained on this form for any purpose connected with my studiesor my health and safety, whilst on college premises, or any other legitimate reason. My consent is conditional upon BSix Brooke House Sixth Form College complying with its obligations and duties under the Data Protection Act 1998. The information provided by me on this application form is accurate.