Student Number
Please complete only the BORDERED WHITE BOXES of the form in BLOCK CAPITALS and in ink. Please return completed application and reference form to:
Registry, The WKCIC Group, 444 Camden Road, London, N7 0SP
Section 1 - Your personal details
Please enter your name as it appears on official documents:
Title: Mr
Mrs
Miss
Ms
Other
Male
Female
Family name/Surname
First name(s)
Date of Birth (DD/MM/YYYY)
Age on 31 August 2017
Unque Learner Number (if known)
Address (please remember to let us know if you
move address after applying/starting your studies) Parental home
Own home
Other (please state)
Postcode
Contact no.
Mobile no.
Email address
Section 2 - The courses you are applying for/enrolling on Centre
Students aged 16–18: The reference form on page 6 must be completed by your school or college before your application can be considered.
Office use
only
AG
Surname/F
amily name
First name
Studen
t number
Westminster Kingsway College
APPLICATION FORM 2017/18
The WKCIC Group is the operating name of Westminster Kingsway College and City and Islington College
Section 3 - Additional support
The College welcomes applications from learners of all abilities and we are committed to supporting applicants through the admissions process. To ensure
that we provide you with the best support available, please indicate any learning difficulties or support requirements that you will need at your interview.
Do you have a disability and/or learning difficulty? Yes
No
Section 4 - Equal opportunities
We are committed to equal opportunities. Please tick the box which best describes your ethnicity:
Asian/Asian British
Indian 39
Pakistani 40
Bangladeshi 41
Chinese 42
Any other Asian background 43
Black/African/Caribbean/Black British
African 44
Caribbean 45
Any other Black/African/Caribbean
background 46
Mixed/multi ethnic group
White and Black Caribbean 35
White and Black African 36
White and Asian 37
Any other mixed/multiple ethnic
background 38
Other ethnic group
Arab 47
Any other ethnic group 98
White
English/Welsh/Scottish/Northern Irish/
British 31
Irish 32
Gypsy or Irish Traveller 33
Any other White background 34
SUP
Please help us to focus the college support and services by answering the following questions:
Are you living in the care of social services, leaving care services or living in any type of hostel accommodation?
Yes
No
Please answer this question if you are aged 14-16
Have you been adopted from care and/or on a Special Guardianship or Residence Order?
Yes
No
Please answer this question if you are aged 14-19
Did you receive Free School Meals in 2016-17? (September 2016 to June 2017)
Yes
No
Learning Difficulty
Moderate learning difficulty 10
Severe learning difficulty 11
Dyslexia 12
Dyscalculia 13
Other specific learning difficulty
(eg. Dyspraxia) 94
Autism spectrum disorder 14
Other learning difficulty. Please specify: 96
I do not wish to give this information 98
No learning difficulty
Disability/Health
Visual impairment 04
Hearing impairment 05
Disability affecting mobility 06
Profound complex disabilities 07
Social and emotional difficulties 08
Wheelchair user
Mental health difficulty 09
Aspergers syndrome 15
Temporary disability after illness
(e.g. post-viral) or accident 16
Speech, Language & communication needs 17
Other physical disability 93
Other medical condition (e.g. epilepsy,
asthma, diabetes. Please specify: 95
Other disability 97
Serious visual impairment
Hearing aid user
I do not wish to give this information 98
No disability
If you require additional support at your interview please specify
EQU
Section 6 - How you heard about Westminster Kingsway College (Westking)
In order that we might target our publicity more effectively, we would be grateful if you would tell us how you heard about Westminster
Kingsway College – please tick all that apply.
Source type
Sources
Internet/
Websites
Westking
HotCourses
Snapchat
LondonColleges
notgoingtouni
YouTube
Other website – please state:
EnglishUK
British council
Emails
Westking
Other email – please state
Text Messages
Westking
Other email – please state
Newsletters
Westking
Other Newsletter – please state:
Radio/TV
Capital
LBC
Heart FM
Kiss FM
Magic FM
Capital Xtra
Smooth
Absolute
Sunrise
XFM
Other radio or TV – please state:
Outdoor
Advertising
Train station – please state which station
Underground station – please state which station
Bus or bus stop – please state:
Prospectuses,
printed media
Westking Prospectus
HotCourses
Parent Guide
Evening Standard
Metro
Other – please state:
Advice providers
Your school
Your college
Careers fair
Westking Advisors
School Open Day
Jobcentre Plus
Employer
Library
LearnDirect
SkillsLondon
International Student Recruitment Agent
Other advice provider – please state
Word of mouth
Family member
Friend
Neighbour
Current student
Past student
Other – please state:
Other
Section 5 - Residency
What is your nationality according to your passport?
What country were you born in?
Have you lived in the UK or the European Economic Area (EEA) for the last 3 years?
Yes
No
If no what countries have you lived in during the last 3 years?
Country From
(DD/MM/YYYY) To
(DD/MM/YYYY)
Is there any limit on your stay in the UK?
Yes
No
If you hold a passport from outside the EEA please answer the questions below:
If you are currently living/staying in the UK do you have a visa?
Yes
No
If yes please indicate below the type of visa you have:
Student Visa Student Visitor Visa Visitor Visa Work Visa
Other, please specify:
RES
MKT
Local press
Section 8 - Education and qualifications
Name and address of the school or college you are/were attending in 2016/2017.
If you have already left school or college, please write the name of the last school/college you attended and when you left.
Date ended (MM/YY)
Please list any qualifications you have, or expect to obtain before you start your course. If English is not your first language, you must indicate which
English language exams you have taken and passed.
Subject
Level
Exam board
Date of exam (MM/YYYY)
Predicted grade
Actual grade
All International students should enclose certified copies of their certificates/qualifications with their application.
QUL
Section 7 - Criminal convictions
Do you have any unspent criminal convictions?
Yes
No
You do not have to tell us about any convictions that are spent (as defined by the Rehabilitation of Offenders Act 1974) , or about any cautions,
reprimands or final warnings. You must disclose all unspent convictions of any offence. For further advice about whether convictions are unspent please
contact the NACRO Helpline on 0800 0181 259.
Do you have any ‘relevant’ criminal convictions (see below)?
Yes
No
‘Relevant’ means offences against a person, whether of a violent or sexual nature and convictions involving unlawful supplying of or possession of
controlled drugs or substances.
Declaring a conviction will not necessarily prevent you from being offered a place at College but failure to disclose something which we later become
aware of could result in disciplinary action. Please note that some of our courses, such as care, childcare or health studies, require you to disclose spent
and unspent convictions, as well as cautions, reprimands and final warnings in the context of legislation on safeguarding children and vulnerable adults.
CC
Section 10 - Declaration and signature
I hereby confirm that the information I have provided is accurate to the best of my knowledge and I understand that this information will be used by the
WKCIC Group (which is the operating name of Westminster Kingsway College and City and Islington College) for admissions, enrolment and reporting
purposes and that some information requested will be stored on computer.
We may also use your details to contact you about the College, its news and events. If you have given us information about a disability or learning
difficulty, the College may pass this information to our Additional Learning Support Team who will work with you to make sure you are supported at
college.
I also understand that placement on a course(s) is subject to meeting entry requirements and availability at enrolment.
All data is stored and processed in accordance with the Data Protection Act.
European Social Fund (ESF) Match Funding: This activity has been directly or indirectly part-financed by the European Social Fund
- helping develop employment by promoting employability, business spirit and equal opportunities and investing in human resources.
By signing this declaration I am confirming that the information I have provided is correct.
Signature of applicant:
Date:
PLEASE NOTE: We require a reference for any applicant aged16–18. Please send this completed application form to your school or other
appropriate referee (not friend or family). Your application may not be considereduntil the referenceformon the last page has been
completed.
Screen Ref FA PhotoID ID
type:
DEC
Section 9 - Tell us about yourself
Tell us why you want to do this course, what skills and experience you have that may be useful when studying this course? (E.g. part-time work, voluntary
work, other courses you have taken in a similar subject.) What do you plan to do after you finish this course? What are your career plans?
Please continue
on a separate sheet of paper if necessary.
PER
Reference Form 2017-2018
1a. Referee’s details
Name
Position
Organisation
Relationship to applicant
Organisation’s address including post code
Telephone no(s)
E-mail address
1b. Applicant details
Name
Date of Birth (DD/MM/YYYY)
Course applied for
Please complete all the sections that are relevant to your knowledge
of the applicant.
2. Subjects
Please indicate in the appropriate box the actual or predicted grade for
each subject.
Level
Grade
Actual Predicted
3. Additional learning needs
Does this applicant require…?
a) ESOL support
Yes
No
Comments
b) Dyslexia support
Yes
No
Comments
c) Other learning support
Yes
No
Comments
d) Particular pastoral support
Yes
No
Comments
e) Disability support
Yes
No
Comments
4. Suitability for the programme
Please tick the suitability of the applicant to undertake the course shown.
Attendance
Excellent
Good
Average
Unsatisfactory
Poor
Punctuality
Excellent
Good
Average
Unsatisfactory
Poor
Behaviour
Excellent
Good
Average
Unsatisfactory
Poor
Motivation
Excellent
Good
Average
Unsatisfactory
Poor
Oral communication
Excellent
Good
Average
Unsatisfactory
Poor
Written communication
Excellent
Good
Average
Unsatisfactory
Poor
Quality of work
Excellent
Good
Average
Unsatisfactory
Poor
Academic ability
Excellent
Good
Average
Unsatisfactory
Poor
Ability to work on own initiative
Excellent
Good
Average
Unsatisfactory
Poor
Attitude to School/College/work environment
Excellent
Good
Average
Unsatisfactory
Poor
Relationships with peer groups and teachers
Excellent
Good
Average
Unsatisfactory
Poor
Ability to work as a member of a team
Excellent
Good
Average
Unsatisfactory
Poor
Has the applicant ever been excluded or suspended?
Yes
No
5. Please use this space to make any comments
(Continue on a separate sheet if necessary)
Signed
Date
Organisation’s official stamp
Please return completed application and reference form to:
Registry, The WKCIC Group,
444 Camden Road, London, N7 0SP
