:: Independent Learning Centre ::

Phone : 0844 567 9996
Email : kiritpatel@independentlearning.org.uk

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Alternative Provision Enquiry Form

International Student Application Form

UK Student Application Form

About the Independent Learning Centre

Course Title
(see prospectus or course leaflet)

Surname/Family Name

First Names

Title

(In case of other)

Date of Birth

Telephone Number (day)

Telephone Number (evening)

Email Address

Address

Postcode

In which country are you normally resident?

Nationality

Have you been resident in the UK for the last three years for other than educational purposes?

Yes No

If no, date of entry to UK

From which country

DISABILITIES
(If you have any disabilities or medical conditions we should know about, please give details)

LEARNING REQUIREMENTS
If you have any specific learning requirements, please give details:

EDUCATION

School/College/University	From Month Year	To Month Year	Qualifications Gained

Other qualifications (except those obtained at school), which you have already achieved

Title of Qualification	Results	Date of Award	Awarding Body

Employment/Work Experience:

Employer	From Month Year	To Month Year	Job title and brief outline of responsibilities

We would like to know more about you and have left this space for you to write briefly about other relevant experience and additional information that may help your application. If required please add additional sheets.

How did you find out about the College and the courses available?

Friends/Relations	Newspaper Advert (please state which newspaper)	Careers Convention
Employer	Radio Advert (please state which station)	Job Centre
Centre Leaflet	Careers Centre/Connexions	Website

CRIMINAL CONVICTIONS
Do you have any criminal convictions?
If yes, please outline details here, including dates of conviction:

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