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Adult Learner Application Form

You are here: Home1 / Adult Learner Application Form

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Apply for an Adult Learner Course

Welcome to our Adult Learner Application Form. Please provide us with as much information as possible to support your application. We will contact you once we receive your form.

Please note that this application form is for Adult Learner Courses only. For Maths and English Adult Courses, Further Education and Higher Education courses please visit the relevant sections on our website.
Course Details
Course applying for*
When do you want to start?*

Address and Contact Details
Name*
Title First name Middle name(s) Last name
Gender*
Date of birth*

Day
Month
Year
National Insurance Number
Address*
Address line 1 Address line 2 City County Post code Country
How many years have you lived at your current address?*
Mobile number*
Alternative contact number
Email address*
Enter Email Confirm Email
Are you a British citizen?*

Nationality
Nationality*
Have you been a resident in the UK/EU in the past 3 years*
Country of residence prior to the past 3 years*
How many years did you live at this address for?*

Education
Please select which of the following applies to you*
Name of current school*
If you can't find your school please enter 'School not listed'
Please confirm you are in year 11*
- I am in year 11
Name of current sixth form/college*
What year are you in?*
Course title*
Course level*
Diploma grade*
AS Level grade*
A Level grade*
BTEC grade*
'Other' grade*
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?*
- Predicted
- Achieved

Qualifications
Do you have any predicted or achieved GCSE or equivalent qualifications ?*
1. Maths Qualification*
Maths Level*
Maths GCSE Grade*
Maths Functional Skills Grade*
Maths O Level Grade*
Maths CSE Grade*
Maths 'Other' Grade*
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?*
- Predicted
- Achieved
2. English Qualification*
English Level*
English GCSE Grade*
English Functional Skills Grade*
English O Level Grade*
English CSE Grade*
English 'Other' Grade*
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?*
- Predicted
- Achieved
3. Science Qualification*
Science Level*
Science GCSE Grade*
Science Functional Skills Grade*
Science O Level Grade*
Science CSE Grade*
Science 'Other' Grade*
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?*
- Predicted
- Achieved
If you are applying for a Level 3 course, you need at least 4 GCSE's at grade 4/C or above (or equivalent)
4th Qualification subject
4th Qualification level
4th Qualification GCSE Grade
4th Qualification Functional Skills Grade
4th Qualification O Level Grade
4th Qualification CSE Grade
4th Qualification 'Other' Grade
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?
- Predicted
- Achieved
If you are applying for a Level 3 Technical Baccalaureate, you need at least 5 GCSE's at grade 4/C or above (or equivalent)
5th Qualification subject
5th Qualification level
5th Qualification GCSE Grade
5th Qualification Functional Skills Grade
5th Qualification O Level Grade
5th Qualification CSE Grade
5th Qualification 'Other' Grade
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?
- Predicted
- Achieved

Support Needs
Do you have any learning difficulties or disabilities?*

Final Steps
Data protection*
Reaseheath College will store the information on this form and other information relating to you whilst attending college subject to the provisions of the General Data Protection Regulation (EU) 2016/679 (GDPR) and the Data Protection Act 2018. Read our privacy notice to find out more about how we use your personal information.
- I agree
I can confirm I am either over the age of 18 or under the age of 18 and have parental consent to apply for a course at Reaseheath College.*
- I agree
I understand that it is my responsibility to ensure that the information disclosed in this application is correct. I understand that disclosure of incorrect information may impact on my eligibility for funding and may result in my liability for fees or charge in relation to my programme of study.*
- I agree
Name
This field is for validation purposes and should be left unchanged.

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Reaseheath College
Nantwich
Cheshire, CW5 6DF

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reaseheath.ac.uk

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Absence line: option 1
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