Application Form

Application Form

16 – 18 Years Only (for 2015 and 2016 places)

Please complete ALL sections of this form and click SEND or alternatively click here to download a Word Document form which you can fill out and send to us or call 01283 213427.

Course Required

Please tick relevant box(s) (more than one route can be selected).

Name of Course/Occupational Area:

Please tick the box below if you do not know which course you want to study

Applicant Details

Title:

Surname:

Forenames (in full):

Previous Surname (if changed):

Nationality:

Date of Birth:

Current Address:

Email address:


Home Tel No. (incl Code):

Mobile:


National Insurance No:

Residency

Have you been living in the UK for the last 3 years?

Normal country of residence:

Date of arrival in UK/EU:

Next of Kin Details

Title:

Initials:

Surname:

Relationship to Applicant (parent, guardian, etc):

Daytime Tel No (incl area code):

Mobile No:

Disability and Additional Support

Chameleon School of Construction can offer a wide range of support to help learners on their course. We welcome learners with disabilities and learning difficulties (including, for example, Dyslexia, Epilepsy, Mobility difficulties and Mental Health problems).

If you consider that you may need some additional support, please complete the following questions:

Do you consider yourself to have a learning difficulty, disability or medical condition that may affect your studies? (eg. Use a wheelchair, have Dyslexia etc)

If yes, please specify the nature of your condition. This will help us to best assess your requirements.

Will you require any alternative arrangements to assist you at initial assessments/interview?


If you ticked yes, we will contact you to discuss.

I agree for the relevant details above to be passed to appropriate Chameleon School of Construction staff in order to assess possible support requirements.

Intended Career

(If undecided, say so, but also indicate where main interests lie)

Employment/Work Experience

Give details of any employment, full-time (F/T), part-time (P/T),
Saturday (S), work experience (WE)

Company:

Duties:

Date:

Hours:

Company:

Duties:

Date:

Hours:

Company:

Duties:

Date:

Hours:

Company:

Duties:

Date:

Hours:

Company:

Duties:

Date:

Hours:

Current Employment (if applicable)

Company Name:

Contact Name:

Contact No:

Name and Address of present or last school/college (if within the last 3 years)

Examination Results and Predicted Grades (include GCSE, AS/A Level, Degree etc)

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Name of Examination:

Level:

Date of Exam:

Predicted Grade:

Result & Grade:

Data Protection Act 1998

Chameleon School of Construction Ltd is registered as a Data User under the Data Protection Act 1998. Personal data is treated in confidence and will not be disclosed to a third party except where the training school is permitted to do so by law or where the applicant has given consent in advance. The personal data collected on this form will be processed and held on a database in order to manage your application. We may use such data for any purpose connected with your studies, health and safety whilst on the premises, or for any legitimate reason. This may include contacting you and your parent/guardian by post, email or telephone (incl SMS) from time to time in connection with your application.

From time to time the college may use your details to send you information.

Do you require this information?

Criminal Convictions

Do you have any previous spent or unspent criminal convictions (excluding traffic offences)?

If yes, please give details (we may contact you to discuss further):

Declaration By Applicant (Please read carefully)

I confirm that the details on this form are accurate and complete. If offered a place, I agree to comply with the training centres policies and procedures when using training centres facilities and understand that full copies of these policies and procedures are available.

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