Online Application

Part 1. Personal Details






Male
Female



Yes
No











Part 2. About You


Part 3. A Level Choices





Part 4. Learner Support


Asperger's syndrome
Autism spectrum disorder
Disability affecting mobility
Dyscalculia
Dyslexia
Hearing impairment
Mental health difficulty
Moderate learning difficulty
None
Other disability
Other learning difficulty
Other medical condition (for example epilepsy, asthma, diabetes)
Other physical disability
Other specific learning difficulty (e.g. Dyspraxia)
Prefer not to say
Profound complex disabilities
Severe learning difficulty
Social and emotional difficulties
Speech, Language and Communication Needs
Temporary disability after illness (for example post-viral) or accident
Visual impairment


Asperger's syndrome
Autism spectrum disorder
Disability affecting mobility
Dyscalculia
Dyslexia
Hearing impairment
Mental health difficulty
Moderate learning difficulty
None
Other disability
Other learning difficulty
Other medical condition (for example epilepsy, asthma, diabetes)
Other physical disability
Other specific learning difficulty (e.g. Dyspraxia)
Prefer not to say
Profound complex disabilities
Severe learning difficulty
Social and emotional difficulties
Speech, Language and Communication Needs
Temporary disability after illness (for example post-viral) or accident
Visual impairment


Part 5. Equality Monitoring


Arab
Asian/Asian British - Any other Asian background
Asian/Asian British - Bangladeshi
Asian/Asian British - Chinese
Asian/Asian British - Indian
Asian/Asian British - Pakistani
Black/Black British - African
Black/Black British - Any other Black background
Black/Black British - Caribbean
Mixed/Multiple ethnic group - Other
Mixed/Multiple ethnic group - White and Asian
Mixed/Multiple ethnic group - White and Black African
Mixed/Multiple ethnic group - White and Black Caribbean
Other
Prefer not to say
White - Any other White background
White - British
White - Gypsy or Irish Traveller
White - Irish


Part 6: Exams to be taken

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 1

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 2

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 3

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 4

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 5

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 6

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 7

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 8

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 9

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade

Exam 10

Exam (e.g. GCSE)

Exam board

Subject

Date to be awarded (dd/mm/yyyy)

Predicted grade


Part 7: Exams already taken

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 1

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 2

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 3

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 4

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 5

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 6

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 7

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 8

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 9

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade

Exam 10

Exam (e.g. GCSE)

Exam board

Subject

Actual / predicted grade


Part 8: Current place of study/school




Part 9: Verification

Protecting your privacy and personal data

Dudley College of Technology is committed to protecting your privacy and personal data. The data captured on this form will be used for processing your application / enquiry and we may contact you using the information provided. The college will not share this information with any other organisation at this stage. For more information on what data we collect, how we use it, and your rights under data protection law please visit dudleysixth.co.uk/privacy-notice.

I consent to the data captured on this form to be used for informing me about college courses, events or learning opportunities (please tick box).