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0800 783 6095

info@dudleysixth.co.uk

 

Online Application

Part 1. Personal details





Male
Female



Yes
No









Part 2. About You


Part 3. A Level Choices


Part 4. Learner Support

At Dudley Sixth we can provide additional help to many students. Please let us know if you are entitled by selecting from the options below or in the space provided.


Visual impairment
Hearing impairment
Disability affecting mobility
Other physical disability
Other medical condition (e.g., epilepsy, asthma, diabetes)
Emotional/behavioural difficulties
Mental health difficulty
Temporary disability after illness (e.g., post-viral) or accident
Profound complex disabilities
Asperger syndrome
Multiple disabilities
Other


Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Other specific learning difficulty
Autism spectrum disorder
Multiple learning difficulties
Other


Part 5: Equality Monitoring



White
English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy or Irish Traveller
Any Other White background

Mixed / Multiple ethnic group
White and Black Caribbean
White and Black African
White and Asian
Any Other Mixed / multiple ethnic background

Asian / Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background

Black / African / Caribbean / Black British
African
Caribbean
Any other Black / African / Caribbean background

Other ethnic group
Arab
Any other ethnic group

Part 6: Exams to be taken

Exam
(e.g. GCSE)
Exam Board Subject
Date to be taken (M/Y)
Predicted Grade

Part 7: Exams already taken

Exam
(e.g. GCSE)
Exam Board Subject Predicted Grade


Part 8. Referee Details








Part 9. Verification

Please enter the characters you see in the image below:



Protecting your privacy and personal data

Dudley College of Technology is committed to protecting your privacy and personal data. The data captured on this form will be used for processing your application / enquiry and we may contact you using the information provided. The college will not share this information with any other organisation at this stage. For more information on what data we collect, how we use it, and your rights under data protection law please visit dudleycol.ac.uk/privacy.

I consent to the data captured on this form to be used for informing me about college courses, events or learning opportunities (please tick box).


 

0800 783 6095