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Given Name(s)

Family Name

NI Number

Age at present

Home Telephone

Date of Birth

Mobile Number

Email Address

Home Address

Previous Post Code (if lived at current address for less than 3yrs

Sex Sex MaleFemale

Home Postcode

Do you consider yourself to have a long-term learning difficulty, health problem or any learning difficulty? Do you consider yourself to have a long-term learning difficulty, health problem or any learning difficulty?YesNo

Do you have a section 139A Learning Difficulty Assessment or Education Health Care Plan? (LDA) Do you have a section 139A Learning Difficulty Assessment or Education Health Care Plan? (LDA)YesNo

If you have a learning difficulty or health problem, please you confirm what kind? If you have a learning difficulty or health problem, please you confirm what kind? Visual impairment (4) Hearing impairment (5) Disability affecting mobility (6) Profound complex disabilities (7) Social and emotional difficulties (8) Mental health difficulty (9) Moderate learning difficulty (10) Severe learning difficulty (11) Dyslexia (12) Dyscalculia (13) Autism spectrum disorder (14) Asperger’s syndrome (15) Temporary disability after illness or accident (16) Speech, Language and Communication needs (17) Other learning difficulty (96) Other physical disability (93) Other specific learning difficulty (e.g Dyspraxia) (94) Other medical condition (e.g epilepsy, asthma, diabetes) (95)

Ethnicity EthnicityWhite - English, Welsh, Scottish, Northern Irish or British (31)White - Irish (32)White - Gypsy or Irish Traveller (33)White - Gypsy or Irish Traveller (33)White - Any other white background (34)Mixed/ Multiple ethnic group - White and Black Caribbean (35)Mixed/ Multiple ethnic group - White and Black African (36)Mixed/ Multiple ethnic group - White and Asian (37)Mixed/ Multiple ethnic group - Any other mixed / multiple ethnic background (38)Asian/ Asian British - Indian (39)Asian/ Asian British - Pakistani (40)Asian/ Asian British - Bangladeshi (41)Asian/ Asian British - Chinese (42)Asian/ Asian British - Any other Asian background (43)Black/ African/ Caribbean/ Black British - African (44)Black/ African/ Caribbean/ Black British - Caribbean (45)Black/ African/ Caribbean/ Black British - Any other Black / African / Caribbean background (46)Black/ African/ Caribbean/ Black British - Arab (47)Black/ African/ Caribbean/ Black British - Any other ethnic group (98)

Are you currently enrolled with any other College or Training Provider? Are you currently enrolled with any other College or Training Provider?YesNo

Qualification in Maths Qualification in MathsAlevelGcseFunctional SkillsKey Skills

Grade GradeABCD

Grade GradeABC456789

Grade GradeLevel 1Level 2

Grade GradeLevel 1Level 2

Qualification in English Qualification in EnglishAlevelGcseFunctional SkillsKey Skills

Grade GradeABCD

Grade GradeABC456789

Grade GradeLevel 1Level 2

Grade GradeLevel 1Level 2

Qualification in ICT Qualification in ICTAlevelGcseFunctional SkillsKey Skills

Grade GradeABCD

Grade GradeABC456789

Grade GradeLevel 1Level 2

Grade GradeLevel 1Level 2

Previous Level 2 Vocational Qualification Previous Level 2 Vocational QualificationYesNo

Previous Level 3 Vocational Qualification Previous Level 3 Vocational QualificationYesNo

Where did you hear about us? Where did you hear about us?From a friendFlyerBL WebsiteNASSocial MediaSalon ReferalCareer EventsSchool Referals

1st Course Choice 1st Course ChoiceSUMMER ACADEMYTRAINEESHIPLEVEL 2 HAIRDRESSINGLEVEL 3 HAIRDRESSINGLEVEL 2 BARBERING PROFESSIONALCERTIFICATE IN ASSESSING VOCATIONAL ACHIEVEMENTLEVEL 3 CERTIFICATE IN ARTIFICIAL NAIL STRUCTURESCITY & GUILDS LEVEL 4 DIPLOMA IN ADVANCED TECHNIQUES AND MANAGEMENT PRACTICE IN HAIRDRESSINGCITY & GUILDS LEVEL 4 DIPLOMA IN ADVANCED HAIRDRESSING TECHNIQUES

2nd Course Choice 2nd Course ChoiceSUMMER ACADEMYTRAINEESHIPLEVEL 2 HAIRDRESSINGLEVEL 3 HAIRDRESSINGLEVEL 2 BARBERING PROFESSIONALCERTIFICATE IN ASSESSING VOCATIONAL ACHIEVEMENTLEVEL 3 CERTIFICATE IN ARTIFICIAL NAIL STRUCTURESCITY & GUILDS LEVEL 4 DIPLOMA IN ADVANCED TECHNIQUES AND MANAGEMENT PRACTICE IN HAIRDRESSINGCITY & GUILDS LEVEL 4 DIPLOMA IN ADVANCED HAIRDRESSING TECHNIQUES