Your Details
First name
Last name
Email
Phone number
Address
Date of birth
Age now
Age next August 31st
Which best describes you?
Female
Male
Other
Prefer not to say
Which Secondary School did you attend most recently?
Select one...
First Choice
Second Choice
Third Choice
Which Course are you applying for?
Select one...
First Choice
Second Choice
Third Choice
Have you been a UK resident for the last 3 years?
Yes
No
Would you like to be part of the College Rugby squad?
Yes
No
Are you in the care of the Local Authority? (This could be either foster care or within a residential home.)
Yes
No
Prefer not to say
Have you recently left care?
Yes
No
Prefer not to say
Ethnicity
Select one...
First Choice
Second Choice
Third Choice
Student Kit sizing:
Shirt
S
M
L
XL
Other
Jacket
S
M
L
XL
Other
Trousers
S
M
L
XL
Other
shorts
S
M
L
XL
Other
Additional Learning Support
Do you have any learning difficulties, disabilities or medical conditions?
Yes
No
If yes, please list any learning difficulties, disabilities or medical conditions below.
How does this affect your learning?
Have you had help at School or another College?
Yes
No
If yes, which School or College?
What kind of help did you have? (e.g equipment, tutor support, in-class support)
Do you have exam access arrangements?
Yes
No
If yes, what arrangements?
Do you have an Education Health Care Plan (EHCP)?
Yes
No
If yes, please provide contact information for your EHCP / SEN keyworker so we may liaise and discuss the additional support needs you have previously received in more detail:
To enable the college to meet your individual learning needs we will need to share the information you give us with other relevant members of college staff.
I agree to this
I do not agree to this
Emergency Contact Information
Steps
0
/
3
Emergency Contact
1
Delete
Add Another Contact
Education
Starting with your present or most recent school. Please list all
secondary schools
attended up to the age of 16.
Steps
0
/
3
School
1
Delete
Add Another School
Qualifications
Please list qualifications gained or to be taken. Please attach copies of all existing examination results or certificates already awarded. (N.B. Irish qualifications: please state whether HIGHER or ORDINARY.)
Steps
0
/
3
Qualification
1
Delete
Add Another Qualification
Further Study
Please list all full-time and part-time courses which you have attempted since the age of 16, even if the course was not fully completed.
Steps
0
/
3
Course
1
Delete
Add Another Course
Personal Statement / Career Ambitions
Please write your personal statement below, including your career ambitions.
Declarations
Criminal Convictions
The College has a duty of care, particularly to learners who are under 18 years of age. In view of this all applicants are required to declare any criminal convictions. All information given will be treated as sensitive data under the Data Protection Act and dealt with in accordance with our Equality and Diversity Policy and Admissions Policy.
Excluding fixed penalty driving offences, do you have any criminal convictions? (If yes, we will ask you to provide details securely.)
Yes
No
Data Protection
This privacy notice is issued by the Education and Skills Funding Agency (ESFA), on behalf of the Secretary of State for the Department of Education (DfE). It is to inform learners how their personal information will be used by the DfE, the ESFA and any successor bodies to these organisations.
The DfE is the data controller for the personal data processed by the ESFA. The DfE will use your personal information to exercise it functions and meet its statutory responsibilities, including maintaining and creating a unique learner number (ULN), a personal learning record (PLR) this will be conducted under the Apprenticeships, Skills, Children and Learning Act of 2009.
Your information will be securely destroyed after it’s no longer required for these purposes. You may inform the College at any time if you no longer wish to receive information about College courses, services and events. Write to
David Smith
, Wigan Warriors College, Robin Park Leisure Centre, Loire Drive, Wigan, WN5 0UL.
Applicant Declaration
I understand that the above information forms the basis on which a place may be offered to me, and declare these particulars are to the best of my knowledge correct. I also understand that the place may be withdrawn if undeclared criminal convictions subsequently come to light.
Applicant Name
Applicant Signature
Clear
Parent/Guardian Name (if applicant is under 18)
Parent/Guardian Signature
Clear
Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.