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Further Education Application Form
For full-time study programmes
How do I use this application form?
Please read the help for each section before completing the form. Once you have completed it click the 'send application' button at the bottom of the page. Your application will then be processed and you will receive a confirmation e-mail.

If you require assistance in completing this form or require a paper version please contact us at:
University College Birmingham, Summer Row, Birmingham B3 1JB.  Tel: 0121 604 1000.  Fax: 0121 608 7100.  e-mail: marketing@ucb.ac.uk
1. Choose course Help
   Year of Entry 
2. Personal details Help
Name
 

Address
 
Town
County
Postcode  
Country
Tel Number (home)
Tel Number (mobile)  
Email Address
Date of Birth  
   
 
In which country are you normally resident? UK Other If Other, please specify 
What is your nationality?  
Have you been resident in the UK for the last three years for other than educational purposes? Yes No
If No, please enter your date of entry to the UK        From which country? 
3. Disabilities Help
If you have any disabilities or medical conditions we should know about, please give details below:
4. Learning requirements Help
If you have any specific learning requirements, please give details below:
5. Education to date Help
      From   To    
School/Institution Town/City (MM) (YYYY) (MM) (YYYY) Full- or Part-time
For example:. My school   My town   09   1993   07   1999   Full-time
       
       
       
       
       
6. Examinations to be taken or with results pending Help
Applicants should list all subjects taken. Full account is taken of relevant experience and other educational achievements.
  I am NOT taking any examinations
        Date    
Level Subject (MM) (YYYY) Place of Study
For example: GCSE   Mathematics   05   2009   MySchool
     
     
     
     
     
7. Examinations for which results are known Help
Applicants should list all subjects taken whatever the result.
  I have NOT taken any examinations
        Date        
Level Subject (MM) (YYYY) Place of Study Result (Grade or band)
For example: GCSE   Mathematics   05   2009   My School   B
         
         
         
         
         
8. Work experience Help
Please give details of employment history/work experience and training.
  I have NO work experience
    Name of   From   To    
Job title and nature of work/training Organisation (DD) (MM) (YYYY) (DD) (MM) (YYYY) Full- or Part-time
For example: Sales assistant working in a shop   Shop name   23   09   2008   31   03   2009   Part-time
               
               
               
               
               
               
9. Additional Information Help
We would like to know more about you and have left this space for you to write briefly about your spare time interests, career plans and what you hope to achieve in the future..
 
How did you find out about University College Birmingham and the courses available? 
If Radio or Newspaper advert please specify which station/newspaper  
Have you attended a University College Birmingham Open Day? Yes No
Have you attended a University College Birmingham Taster Day? Yes No
Have you attended a University College Birmingham Work Experience Placement? Yes No
10. Criminal convictions Help
Do you have any criminal convictions? Yes No
If Yes, please outline details here, including dates of conviction
11. Declaration Help
I confirm that the information given on this form is true, complete and accurate and no information that has been requested has been omitted.
I undertake to be bound by the University College Birmingham's General Student Regulations and I also give consent to the University College Birmingham for the processing of my data for administrative purposes as required (in accordance with the Data Protection Act 1998). I accept that if I do not comply with these requirements, the University College Birmingham has the right to cancel my application and I shall have no claim against University College Birmingham.
IMPORTANT: If the applicant is under 18 years of age the following undertaking must be given by the parent or guardian and their name and address must be entered below:
In the event of the above named student being in default of payment, I undertake the responsibility for the payment of any uniform or equipment costs due.

Parent/Guardian Name  
 

Address
 
Town
County
Postcode  
Country
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