Application Form 2013/14 - West London College of Business and

2013/14
Application Form
WLCBMS
1. Personal Information
Photo
Please complete this form in CAPITAL Letters
Title (Mr/Miss/Mrs/Ms)
First Name
Surname
Prev. Surname (if any)
Date of Birth D D M M Y Y Y Y Gender
Male
Female Other
Immigration Status:
Nationality
Date of Entry in United Kingdom D D M M Y Y Y Y
Who’s paying your fee?
Home Address
Street
ULN
Building Society
Tel. No. (Home)
Tel. No. (Work place)
Town
Mobile No.
County
Email Address:
Post code
2. Next of Kin
Title (Mr/Miss/Mrs/Ms)
First Name
Surname
Relation
Home Address
Street
Tel. No. (Home)
Building Society
Tel. No. (Work place)
Mobile No.
Town
Email Address:
County
Post code
3. Programme of Study Selection
Programme of Study
Intention to start study in?
January
May
Course Level
September
Year 20___
English Proficiency:
Is English your first language
Yes
No
If answered no then, what is your first language
Have you attended any studies in English Language
Do you have IELTS/TOEFL/TOEIC
No
Yes
No
Yes, Score & test type?
Do you have written evidence of your English ability from your previous
education establishment
Yes
No
Full Time/
Part Time
4. Previous Qualification
Qualification
Year
Institution
5. Work Experience
Employer Details
Duration
Designation - Responsibilities
6. Personal Statement
7. Data Protection & Criminal Convictions
Do you have any Criminal Convictions or have you received a Reprimand or Final Warning from the police?
Yes
No
If yes please state:
Data Protection:
The WLBMS uses this application form to collect information about you for various administrative, academic and health and safety
reasons. The Data Protection Act 1998 requires you to sign the ‘consent to process’ clause and answer the following question.
This is personal, sensitive information and we require your consent before we can process your form. If you require any further
information about this, please contact the Principle at the college centre you wish to study at. This information may be shared
with other government and educational organisations for the purposes of administration, careers and other guidance.
I agree to WLCBMS processing personal data, including data about my ethnicity, any criminal convictions and my physical or mental
health, contained in this form, or other data, which WLCBMS may obtain from me or other people. I agree to the processing of such
data for any purposes connected with my course application or my health and safety, or any other legitimate reason.
8. References (Name, Address, Telephone, email)
Referee 1
Referee 2
9. Terms & Conditions
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Student must be at least 18 years of age
The course fee must be paid in full before commencing the studies, unless an instalment plan has been agreed with
the Director of Finance
Students found to have difficulties in following a course due to inadequate language skills; will be required to follow
a remedial course in English Language at WLCBMS until their level of English reaches a required standard
Students unable to join their courses by the schedule date must inform the college in writing at least two weeks prior
to the starting date of the course
No student will be enrolled on a course unless and until approved by the academic board of the College
Students who are late in starting their course will not be entitled to any refund, or reduction in tuition fees; this also
applies where students have been absent from class for a period of time and where they may not have been
attending all the subjects from which they have been enrolled
If supporting documents provided with application, found not to be genuine, admission will be cancelled immediately
and any fee paid will not be refunded
The College reserves the right not to run a particular course due to the unavoidable circumstances and to transfer
students to an alternative course
The College reserves the right to make changes to the structure and content of courses
The College reserves the right to refuse admission to any student
Students are required to keep the college informed of any change of address or contact details
In the event of a student being dismissed by the college, fees will not be refunded
Anyone breaking the law, violating WLCBMS rules and discipline is liable to suspension/termination from WLCBMS
Important notices to students are displayed on the main notice board and it is the student’s responsibility to read
such notices
Declaration
I confirm that the statements made by me on this form are correct. Should any of the above statements prove to be
incorrect the College reserves the right to withdraw any offer made or cancel any subsequent registration with the College.
I undertake to be bound by the terms set out in it and I give my consent to the processing of my application.
Signature
Date
10. Documents Checklist
Please provide the following supporting documents:
Passport size photographs
Passport copy
Academic references
Copies of academic documents
Copies of IELTS/TOEFL etc. Certificates
Work Experience
Proof of address
Evidence of sponsorship (if applicable)
Employment references
11. For WLCBMS use only:
Student Registration Number:
Fee Status:
Remarks:
Home
Overseas
Course Start Date:
Other:
Admission Status:
Approved
Rejected
12. Equality and Diversity Monitoring
At WLCBMS we are committed to providing equal access and equal chances for all our students. As part of this, we
monitor data on student gender, age, Marital status, ethnicity, sexual orientation, religious beliefs and disability.
The information you provide is used only to help us monitor whether all our students have an equal chances to
progress and succeed.
Please indicate your religion or belief:
I don’t wish to disclose my religion/belief
Please select the option which best describes your sexual orientation (please tick one)
Straight/Hetrosexual
Gay/Lesbian
Bisexual
I don’t wish to disclose my sexual orientation
Ethnic Origin
Mixed - White Black African Carribean
Black or Black - British - Caribbean
Mixed - any other mixed background
Black or Black - British any other Black background
White - British
Chinese
White - Irish
Mixed - White and Black Asian
White - any other White background
Mixed - White/Black African
Gypsy or Irish traveler
Arab
Any other
Asian or Asian British - Bangladeshi
Not known/not provided
Asian or Asian British - Indian
Black or Black - British - African
Asian or Asian British - Pakistani
Asian or Asian British - any other Asian background
Disability
We are committed to meeting the needs of people with learning difficulties and disabilities.
Do you consider yourself to have any disability?
Yes
No
If yes please state your disability:
Visual Impairment
Other disabilities
Hearing Impairment
Moderate learning difficulties
Disability affecting mobility
Severe learning difficulty
Other physical disability
Dyslexia
Emotional/beahvioural difficulties
ADHD
Mental health difficulty
Dysalculia
Temporary disability after illness
Dyspraxia
Profound/complex disabilities
Autism
Asperger’s Syndrome
Other learning difficulties
Multiple disabilities
Multiple learning difficulties
English as another language
Do you consider yourself to require any support
Yes
No
If yes, please specify:
Campus Location
West London College of Business & Management Sciences
Vista Business Centre, 50 Salisbury Road, Hounslow, Middlesex, TW4 6JQ, United Kingdom
Email: [email protected] URL: http://www.wlcb.co.uk, Tel: +44 (0) 208 538 0224, Fax: +44 (0)208 538 0225