Course Application - Confetti Institute of Creative Technologies

YOUR DETAILS

First Name*

Middle Name

Last Name*

Title

Mr.
Mrs.
Miss.
Ms.

Date of Birth*

National Insurance No.

Unique Pupil Number

13 digit number assigned to you when starting state funded school

Address*

Street Address Address Line 2 City ZIP / Postal Code

Home Phone

Mobile Phone*

Email*

Pick your preferred method of contact*

Are you over or under 18?*

I am over 18
I am under 18

Parent/guardian name*

If you are under the age of 18, please provide the name of one of your parents/guardians.

First Last

Parent/guardian email*

Parent/guardian phone number*

Emergency contact name*

First Last

Emergency contact phone number*

Emergency contact email*

Relationship to you*

ETHNIC ORIGIN

How would you describe your ethnic origin?*

If you chose "White" please select from the below

British / Welsh / Scottish / Northern Irish
Irish
Gypsy or Irish Traveller
Any other White Background

If you chose "Mixed / Multiple Ethic Group" please select from the below

White and Black Caribbean
White and Black African
White and Asian
Any other Mixed / Multiple Ethnic Background

If you chose "Asian / Asian British" please select from the below

If you chose "Black / African / Caribbean / Black British" please select from the below

African
Caribbean
Any other Black / African / Caribbean Background

If you chose "Other Ethnic Group" please select from the below

Arab
Any other Ethnic Group
Prefer not to say

What is your nationality?*

Are you an asylum seeker? (Please enclose copies of your Home Office letters.)*

Yes
No

Do you have refugee status? (Please enclose copies of your Home Office letters.)*

Yes
No

Have you lived in the UK or other EU country for the whole of the last three years?*

Yes
No

If no, please state where you have lived (a fee assessment may be required before proceeding):

ADDITIONAL NEEDS AND EXTRA SUPPORT

Confetti acknowledges differences and values and supports all learners. Please answer the following, giving as much details as possible. If you answer yes to any questions you will be contacted to discuss support.

Are you in care of the local authority or with the leaving care team?*

Yes
No

Do you have an Education, Health and Care Plan?*

Yes
No

Do you have any additional learning need which will require extra support?*

Yes
No

Please let us know any additional learning needs:

Qualification (E.g. GCSE English, A Level Maths, BTEC L2 Diploma in Media.)	Predicted Grade	Grade Achieved	Year of Exam

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YOUR DETAILS

ETHNIC ORIGIN

ADDITIONAL NEEDS AND EXTRA SUPPORT

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