Adult Application Form

Please select or input course/(s) applying for: i.e. ESOL/English/Maths/TA/Tailored Learning

Course Course/(s) applying for

Personal Details

Title

First Name

Surname

Date of Birth

Sex

Male Female

Address Address Line 1 * Address Line 2 Address Line 3

Town *

County

Postcode *

National Insurance Number (e.g. AB123456A)

You will be required to show proof identification at your enrolment appointment, please provide original, in-date documentation such as passport or driving licence.

Contact Details

Contact Telephone Number

Email Address

Emergency Contact Name

Emergency Contact Tel Number

Ethnic Origin

Is English your first language?

Yes No

If No, please state your first language

Ethnicity Nationality

Residential Status Are you currently a permanent resident in England?

Yes No

Do you require a Visa to reside in the UK?

Yes No

If yes, please provide share code Are you an Asylum Seeker?

Yes No

You will be required to show proof of your residential status at your enrolment appointment, please provide documentation that shows your current address such as driving licence, utility bill or housing documents. BRPs (Biometric Residence Permits) and BRCs (Biometric Residence Cards) have been replaced by eVisas. While you may still possess an old physical card, it is no longer valid, and you must use the digital status option and provide a share code.

Employment Status

Please select your employment status as it will be on the day before your course starts.

After selecting your status, complete the relevant section below.

Employed (Complete Section 1) Self-employed (Complete Section 1) Unemployed (Complete Section 2) Retired / Not in paid employment (Complete Section 2)

Section 1 - Employed or Self-employed How many hours do you normally work per week?

Example: 15 hours per week

How long have you been employed/self-employed?

Example: 6 months

Section 2 - Unemployed or Not in Employment How long have you been unemployed/not in employment?

Example: 6 months

Financial Situation Declaration

You do not need to complete this section if you are enrolling to a course as part of the legal entitlement, i.e. Maths and/or English GCSE or Functional Skills.

Please tick any that apply:

Job Seeker’s Allowance (JSA)

Employment and Support Allowance (ESA) (WRAG)

Universal Credit

Other state benefit

I am enrolling on a level 2 or below qualification and am undertaking this course to assist my entry to employment. I am currently in receipt of Universal Credit or other state benefit, and my take home pay disregarding UC payments and other benefits is less than £952 per month, or £1534 per month for a joint benefit claim with partner.

I am enrolling on a level 2 or below qualification, am employed and in receipt of less than £26,800 gross annual income.
If your gross annual income is more than £26,800, you may be required to pay additional course fees.

Self-funded/Employer Funded

None of the above

You will be required to show proof of your financial status at your enrolment appointment.

Disability/Learning Difficulties I have a disability or a learning difficulty

Yes No

Difficulty/Disability	Tick
Visual Impairment
Hearing Impairment
Disability affecting mobility
Profound Complex Disabilities
Social and Emotional Difficulties
Mental Health Difficulty
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Autism Spectrum Disorder
Temporary disability after illness or accident
Other physical disability
Other specific learning difficulty
Other Medical Condition (e.g. epilepsy, diabetes, asthma)
Other Learning Difficulty
Other disability
I prefer not to say

Previous Qualifications

If you’re unsure, please choose the qualification level that you feel best matches what you achieved in the UK or in your home country. We will discuss your previous qualifications in more detail during your enrolment appointment.

Prior level

English grade achieved or N/A?

Maths grade achieved or N/A?

Consent Checks Photo Consent

I consent to Cirencester College to use or re-use my photographic image or moving image of me, in whole or in part, in any publication or other media.

Yes No

By submitting this form, the applicant confirms the information provided is accurate and understands that the submitted timestamp will be recorded.

How Cirencester College Uses Your Information:

While you study with us the College will hold information relevant to your learning as well as physical and emotional support, we will not hold anything that is not for the express aim of supporting you. Part of this requires the college to pass information to other companies, such as for our online shop, as well as Government agencies such as the Department for Education. We will not pass information to anyone other than to help you. In some circumstances we will pass contact information in support of government initiatives, in such cases you will then have an option to opt into the service. A year after you have left the College, we will anonymise the information we hold other than core things such as your name, the programme you studied and the grades you got which we hold for as long as we are legally obliged to. There is a full list of the information we hold, why we hold it, how long we hold it for and who we pass it to available on the student zone.