InternatIonal applIcatIon FormPlease complete all relevant sections in full. See our ‘Guidance Notes’ for detailson how to complete this application. For further assistance, please contact theadmissions office on t +44 (0)1253 504 322 or by e admissions@blackpool.ac.uk

1. personal DetaIls

FamIly name

tItle

GenDer Date oF BIrth aGe at 31/07/2013

home aDDress (including country)

Is this the country where you permanently reside? If No, please state:

telephone numBer (with country code)

emaIl aDDress

country oF BIrth

FIrst lanGuaGe Date oF FIrst entry to lIve In uK

2. course choIce Your chosen FE course must be at least 15 Guided Learning Hours (GLH) per week. For all undergraduate courses, please apply via UCAS.

Further eDucatIon course esol course

course tItle

Why have you chosen to study in the UK?

Why have you chosen to apply to Blackpool and The Fylde College?

FIrst name(s)

natIonalIty

Mr

Male

Yes No

Female

Mrs Miss Ms Other

D m m y y y yD

D m m y y y yD

Have you previously studied in the UK? If yes please provide the following information

Have you ever been refused a visa or entry to the UK? If yes, please provide details of when and under what circumstances

What do you intend to do on completion of your course in the UK?

How do you plan to fund your course fees and living costs in the UK? Please provide the name of the bank/financial institution which you will be using to evidence your finances available to support your visa application.

From

name anD aDDress oF employer(s)

Current Employer

From Date to Date BrIeF DescrIptIon oF worK

to resultcourse stuDIeD (including qualification)

Yes

Yes

No

No

3. employment / worK experIence

name anD aDDress oF schools / colleGes

QualIFIcatIon stuDIeD

From Date

suBject(s)

to Date

actual GraDe(s) achIeveD

Date achIeveD /Due to achIeve

4. eDucatIon anD QualIFIcatIons

5. passport

current level oF enGlIsh IELTS score TOEFL PEARSON GCSE / O Level

passport numBer

name as shown on passport:

expIry Date

6. aDDItIonal support / DeclaratIon oF a DIsaBIlIty

Do you have a disability, medical condition or learning difficulty? If yes please state:Yes No

7. Further InFormatIon Please use this space to include any further information that may be relevant to your application

DeclaratIon

Data protectIonThe information contained in your application will be used primarily for the purpose of processing your application and, if you are admitted, it will become part of your student record. All data is held and processed in accordance with the requirements of the Data Protection Act 1998. Additionally applicant data is analysed by the College, for purposes including institutional and statutory monitoring, market research, planning and teaching and learning and any other relevant function, in order to ensure that our processes are fair and effective and our courses best reflect applicant need.

Do you have a criminal conviction(s)? (see guidance notes)

I certify that I have read the Guidance Notes and the details given by me are correct:

now save the application form and email it, along with scanned copies of: • your passport (and Visa, if you have one) • your qualifications (declared on your application) • your IELTS, Pearson or TOEFL Certificate • any relevant referencesto admissions@blackpool.ac.uk Please do not send original documents in the post.

Yes No

sIGnature Date D m m y y y yD

Guidance notes

1. Personal details

Please complete all sections. It is important that you provide us with a valid email address. If any of your personal details change once you submit your application, please email admissions@blackpool.ac.uk with your new details.

2. course choice – Please note for all Undergraduate courses, please apply via UCAS

Clearly state the full title of the course you wish to study. These can be found either in our prospectus or on our web site www.blackpool.ac.uk If you have selected a Further Education Course the UK Border Agency visa requirements will only allow you to study a Level 3 course that has 15 (or more) Guided Learning Hours per week. Please check our website or the relevant school on +44 (0)1253 352 352 for details.

If you wish to apply for a full time Undergraduate course, you will be required to complete an online application form using UCAS (Universities and Colleges Admissions Service). They can be found at www.ucas.com

You must answer all the questions regarding study in Section 2.

4. education and Qualifications

Please complete all education and qualification information with the most recent first and showing your current level of English in one of the boxes provided. Please scan and email copies of your qualifications with your application to admissions@blackpool.ac.uk. Do not send the originals or photocopies in the post. Please note that for the English Language qualifications, these will only be valid if they are dated within 2 years of the start of the course date. If you are offered a place and you enrol with us, your original certificates will be required at enrolment.

5. PassPort

All fields need to be completed. The passport number is the long number usually in the top right hand section of your passport. Please also include the expiry date and confirm your name as it is shown in your passport. Please scan a copy of your passport and any visas inside and forward these to admissions@blackpool.ac.uk with your completed application form and any other supporting documents.

6. additional suPPort / declaration of a disability

If you indicate you have a disability, medical condition or learning difficulty, we will pass this information to our Learning Support team. If you are offered a place that you accept, our Learning Support team will need to assess your requirements (we will not take this information into consideration when making a decision on your application). Please note that there may be costs attached to additional support.

3. emPloyment

This section allows you to provide us with your employment history and work experience. Start with your current employer and give a brief description of your job. If you do not have a job currently, please state this.

These guidance notes are to help you complete the International application form. Please ensure you fill in all sections. By not completing this in full, you may delay a decision on your application.

7. Further InFormatIon - Please use this space to include any further information that may be relevant to your application.

Please use this section to provide any further information that you feel will support your application that you have not included elsewhere.

8. DeclaratIon

you must tick the yes box if you have any convictions for offences against a person, whether for violence, convictions of a sexual nature or convictions for offences involving unlawfully supplying controlled drugs or substances where the conviction concerns commercial drug dealing or trafficking. You do not need to tell us about convictions that are spent (as defined by the Rehabilita-tion of Offenders Act 1974). However, for courses in teaching, health, social care, gaming and courses involving working with children or vulnerable adults as well as courses that feature a work placement, any criminal convictions, including sentences and cautions (including verbal cautions), reprimands, final warnings and bindover orders are exempt from the Rehabilitation of Of-fenders Act 1974. In other words, if you are applying for one of the above courses and have a criminal conviction, you must tick the yes box. If you do tick the yes box we will then contact you for more information.

You must also tell us about any convictions, verbal cautions, reprimands, final warning and bindover orders (or their equivalent) received in any jurisdiction. If you are in any doubt as to whether such details should be disclosed, you should contact The Head/Manager of student services on +44 (0)1253 352 352 to discuss this. You should note that you have a strict duty to disclose this information to us because it may affect a decision to accept you on the course and/or whether you can undertake a necessary course work placement at a later date. We may require you to obtain official certification of your criminal record or good conduct from the relevant jurisdiction’s criminal register, before making a decision upon your application.

you may also be subject to statutory background checks to assess your suitability to undertake any placements required as part of your course. If this is not possible you may be asked to provide a certified police check. If you are convicted of one of the above criminal offences after you have applied, you must let us know immediately. again, we will then ask you for more details.

False InFormatIon If any information provided is subsequently found to be false any offers can be withdrawn and learners may be asked to leave the course.

Data protectIon The information contained in your application will be used primarily for the purpose of processing your application and, if you are admitted, it will become part of your student record. All data is held and processed in accordance with the requirements of the Data Protection Act 1998. Additionally applicant data is analysed by the College for purposes including institutional and statu-tory monitoring, market research, planning and teaching and learning and any other relevant function, in order to ensure that our processes are fair and effective and our courses best reflect applicant need.

once you have signed and dated the application, you will need to save a copy and email this to admissions@blackpool.ac.uk along with any supporting documents that are required.

helpFul InFormatIon / contacts

• You can contact us on +44 (0) 1253 504322 admissions office, Blackpool and The Fylde College, Ashfield Road, Bispham, Lancashire, FY2 0HB, United Kingdom

• More information regarding our courses and about the college can be found at www.blackpool.ac.uk

• Tier 4 Student Visa requirements can be found at: http://www.ukba.homeoffice.gov.uk/visas-immigration/studying/adult-students/

• The UK Council for Student Affairs (UKCISA) also provides helpful information at: http://www.ukcisa.org.uk/

GuIDance notes