Application form Reference No.

(for office use only)

Please return this form in an envelope to: Amrit Phagura, International Officer,
Uxbridge College, Park Road, Uxbridge, Middlesex, UB8 1NQ, UK  PLEASE COMPLETE IN BLOCK CAPITALS USING A BALLPOINT PEN

1. Personal details

Surname Mr Mrs Miss Ms

First name/s
Address
Postcode
Telephone Mobile
Email

Date of birth (dd/mm/yy) Age on 31st August (in the year of admission)
If under 18, name of parent or guardian
Parents’ contact telephone number: Home Mobile
Country of birth

1.2 Have you been permanently resident in the UK/EU for the past 3 years? Yes (go to 1.3) No (go to 1.4)
1.3 Do you require a visa to study? Yes (go to 1.4) No (go to 2)
1.4 (i) Please give details of entry to the UK
(ii) Which category best describes your situation when you plan to study with us?
British/EU citizen Work permit Student visitor visa Student visa Awaiting permanent settlement
Au pair Other, please specify

2. Course details
I would like to be interviewed for admission to the following course:
Course name Course code
(must be completed)
3. Education
Are you currently at school or college? Yes No If yes, are you studying Full-time Part-time
If yes, please give name of school or college and tutor

3.1 Please list all the qualifications you already hold or are currently studying (continue on a separate piece of paper if necessary):

Name of school or college Qualifications and subjects studied Date completed Grades received

Is English your first language? If not: a) What is your first language?

Yes No b) Please write your IELTs, or equivalent English language test score here:

4. Personal statement
Please note: This section is very important and will form part of your assessment for your application.
Please attach a handwritten personal statement, a minimum of 250 words long. It should be in English and should explain your reasons for
choosing the course, including:
• What you have achieved in your education so far • Any work experience you have done that is relevant to the course
• Why you are interested in the subject you have chosen • Any social activities or sports you are interested or involved in.
• Your future career plans
Application form continued
5. Course fees and sponsor information
Please tell us who will pay your course fees. We will require a letter from you or your sponsor to confirm this.
5a I will be responsible for paying my own fees 5b A sponsor will pay my fees
5c An overseas organisation/government will pay my fees 5d My employer will be paying my fees 5e Other

Please fill in the details below if you tick any of the boxes 5b-5e
Mr Mrs Miss Ms First name Surname
Sponsor name (if applicable)
Sponsor address

Country Telephone
Email

6. Accommodation
Please specify where you plan to live while you study at Uxbridge College:
With a friend or relative A rented room in a private house Homestay (living with a family)
Other (please specify)

7. Special requirements
Do you have a disability or learning difficulty? Yes No
If yes, please indicate what kind of disability or health issue you have:
Visual impairment Hearing impairment Physical disability Dyslexia Asperger’s/ASD Epilepsy
Other (please specify)

8. Please indicate how you heard about Uxbridge College

I already study at the College Prospectus/Leaflet Poster Friend/Relative – word of mouth
Website/Internet Agent/Counsellor Newspaper Education/Careers Fair
Other (please specify)

Notice to applicants
Under the terms of the Data Protection Act 1998, the personal information supplied by you will be treated in confidence, but may be used
internally for other purposes and some of the information on this form will be sent to the Department for Children, Schools & Families for
statistical purposes.

I hereby declare that all the information above is correct and apply for admission to Uxbridge College.

Signature of the applicant Date

Application checklist
To help us process your application quickly, please make sure you have enclosed the following:

A copy of your Passport photograph page A CV/letter/testimonial to prove work experience

(if applicable)
Copies of your examination certificates
Your personal statement (see part 4 for details)
Copy of your IELTS certificate (if applicable) This is very important

A reference from your current or recent school/college Remember to sign and date this form.

Carefully tear along perforation to detach.