1 Personal Details2 Course and Qualifications3 Declaration YOUR DETAILSFirst Name*Middle NameLast Name*Title*Mr.Mrs.Miss.Ms.Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920National Insurance No.Unique Pupil Number13 digit number assigned to you when starting state funded schoolAddress* Street Address Address Line 2 City ZIP / Postal Code Home PhoneMobile Phone*Email* Pick your preferred method of contact*Home PhoneMobile PhoneWork Phone (If applicable)EmailEmergency contact phone number*Emergency contact email* Emergency contact name* First Last Relationship to you*ETHNIC ORIGINHow would you describe your ethnic origin?*Please selectWhiteMixed / Multiple Ethnic GroupAsian / Asian BritishBlack / African / Caribbean / Black BritishOther Ethnic GroupIf you chose "White" please select from the belowBritish / Welsh / Scottish / Northern IrishIrishGypsy or Irish TravellerAny other White BackgroundIf you chose "Mixed / Multiple Ethic Group" please select from the belowWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed / Multiple Ethnic BackgroundIf you chose "Asian / Asian British" please select from the belowIndianPakistaniBangladeshiChineseAny other Asian BackgroundIf you chose "Black / African / Caribbean / Black British" please select from the belowAfricanCaribbeanAny other Black / African / Caribbean BackgroundIf you chose "Other Ethnic Group" please select from the belowArabAny other Ethnic GroupPrefer not to sayWhat is your nationality?*Are you an asylum seeker? (Please enclose copies of your Home Office letters.)*YesNoDo you have refugee status? (Please enclose copies of your Home Office letters.)*YesNoHave you lived in the UK or other EU country for the whole of the last three years?*YesNoIf no, please state where you have lived (a fee assessment may be required before proceeding):ADDITIONAL NEEDS AND EXTRA SUPPORTConfetti 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?*YesNoDo you have an Education, Health and Care Plan?* Yes No Do you have any additional learning need which will require extra support?*YesNoPlease let us know any additional learning needs: Autistic Spectrum Attention Deficit Hyperactivity Disorder (ADHD) Obsessive Compulsive Disorder (OCD) Pathological Demand Avoidance (PDA) Dyslexia Attention Deficit Disorder (ADD) Dyspraxia Dyscalculia Dysgraphia Cerebral Palsy Learning Difficulty Physical disability Visual impairment (VI) Hearing impairment (HI) Mental health condition Social, emotional and mental health (SEMH) English as a Second Language (ESL) Epilepsy COURSE DETAILSAre you applying to start in September 2019 September 2020 Which course are you applying for? (Tick those that apply.)* Introduction to the Creative Industries - BTEC Level 1 Music Technology & Performance – BTEC Level 2 Music Performance & Songwriting - BTEC Level 3 Film & TV Production - BTEC Level 3 VFX & Animation - Level 3 Digital Media - BTEC Level 2 Graphic & Digital Design – BTEC Level 3 Music Technology - BTEC Level 2 Audio & Music Technology - BTEC Level 3 Technical Events – BTEC Level 3 Games – AIM Level 2 Games Technology – Level 3 Games Art - BTEC Level 3 REFERENCE DETAILSIf you are still at school/college, you need to supply the name of a current teacher. If you are not at school/college, your reference needs to be from someone who has known you in a professional capacity. References should not be any older than two years. We are unable to accept references from friends or relatives. Referee Name:*Relationship to you:*How long have you known them:*Email:* Phone*Telephone Number:Company/Institution*QUALIFICATIONSList all qualifications you are taking or have already achieved. For year 11 school leavers please write down your predicted grades.Most recent school/college*Grades*Qualification (E.g. GCSE English, A Level Maths, BTEC L2 Diploma in Media.)Predicted GradeGrade AchievedYear of Exam Have you attended Confetti before?*YesNoIf yes, please give your tutor’s name:Have you applied elsewhere?*YesNoIf yes, please say where: HOW DID YOU FIND US?Where have you seen Confetti advertised?* I heard a radio/digital radio/online streaming service advert I saw a bus advert I saw a tram advert I saw a TV advert I saw a cinema advert I saw a post on Twitter/Facebook/Instagram I saw a video on YouTube I searched on Google/Bing/other search enginge I spoke to someone at a UCAS Fair I was advised by a referral agency (Futures, Job Centre etc.) I spoke to someone at my school/college careers event I attended a taster session with my school I visited Confetti with my school I was advised by my school/college advisor/tutor I was advised by a friend/family member Other (please specify below) Tick as many boxes as requiredCommentsYOUR DECLARATIONHave you any unspent criminal convictions?*YesNoAre you currently on probation or serving a non-custodial sentence or awaiting court cases?*YesNoAre you currently on any orders, e.g. SOPO, ASBO?*YesNoSignature*Confetti Media Group (CMG) positively welcomes students and customers from all communities. I declare the information given on this form is correct and accurate to the best of my knowledge, and I understand that information I supply will be held by CMG and shared with third parties in order to provide CMG’s services, as outlined in our Privacy Notices. By signing this declaration I am providing consent for CMG to contact my referees using the contact details supplied and others agencies in regards to my application. Further information regarding how we process, store, and use your data can be found in our Privacy Notices – available here https://confetti.ac.uk/privacy-policy/ I have read and understood the declaration
