SKL College of Excellence Int Application for admission Please complete this form in BLOCK CAPITALS Course Details Course Code Course Title Start Date(mm/dd/yyyy) Study Mode Personal Details Title (Mr,Mrs,Miss,Ms etc) FirstName Surname Please state your name in the style you require it to appear on your certificate. Address Permanent Home Address Address for correspondance (if different) Town Country/State Postcode Country Tel/Mobile Email Town Country/State Postcode Country Tel/Mobile Fax Sex Marital status MaleFemale MarriedSingleDivorcedWidowed Date Of Birth (mm/dd/yyyy) Country Of Birth Nationality Mother Tongue Academic Record Please give details of the last two educational establishments attended Name Name Type of Institution (Primary, Secondary, College etc) Address Address Date of Entry(mm/dd/yyyy) Date of Leaving(mm/dd/yyyy) Date of Entry(mm/dd/yyyy) Date of Leaving(mm/dd/yyyy) Educational Qualifications School Examinations Taken Year Examining body Type of Exam Subjects taken with grades State your level of English proficiency BeginnerBasicIntermediateAdvanced Diploma or other certificate Date passed (mm/dd/yyyy) College Address Award/Grade Other Qualifications (Academic & Professional) Date (mm/dd/yyyy) Professional body/awarding institution Award achieved Academic Reference Please give details of two persons we should contact for academic reference. Title (eg. Dr, Mr, Mrs) Title (eg. Dr, Mr, Mrs) First name First name Surname Surname Address Address Tel Tel Sponsor Details (Who is going to pay your fees?) Relationship First name Surname Address Tel Email Checklist Please complete all sections of the application form. Include the correct fees(Cheques payable toSKL College of Excellence Int) A place can only be reserved once the fees have been received. Please note that £300 administration fee is not refundable.Read carefully the rules and regulations in the prospectus before completing this form. Failure to complete the form in full may result in delays processing your application. Please submit all ts. necessary documents. Residence Status Do you require a visa permitting you to stay in the UK? YesNo If Yes please indicate status StudentTouristOther If No please indicate status VisitorWork PermitOther If other please explain Equal Opportunities Monitoring How would you describe your ethnicity BlackCaribbean African Indian WhiteOther Health Are you in a Good Health? YesNo Please give details of any medical condition or disability and any way in which we may help you at your interview and whilst at college. The Disability Discriminations Act identifies support needs as listed below. If you feel that any of the following categories apply to you, please choose where appropriate and add comments accordingly. Visual impairment Hearing Impairment Disability affecting mobility Other physical mobilityOther medical condition (eg. epilepsy, asthma, diabetes)Emotional/behavioural difficulties Mental ill health Temporary disability after illness or accident Profound complex disabilitiesAsperger's SyndromeMultiple disabilities Other No disability Not known/information not providedModerate learning difficultySevere learning difficultyDyslexia Dyscalculia Other specific learning difficultyAutism Spectrum disorder Multiple learning difficulty OtherNo learning difficulty *Support: Have you received any special learning support at school? (eg. Have you had extra time in exams or a statement of educational need ?) YesNo If Yes, please give brief details: Would you like a Learning Support member present at your interview? YesNo SKL College of Excellence Int SKL House, 18 Beresford Avenue Wembley - HA0 1YP Tel: +44 020 8900 1777 Fax: 020 8900 1130 Email: info@sklcollege.org.uk Website: http://www.sklcollege.org.uk Company registration Number: 3835312