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Adult Learner Application Form
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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
*
Please select
Garden Design
When do you want to start?
*
Please select
2nd February
16th February
9th March
Unsure
Address and Contact Details
Name
*
Title
Mr
Miss
Mrs
Ms
Dr
Prof.
Rev.
First name
Middle name(s)
Last name
Gender
*
Please select
Male
Female
Prefer not to say
Date of birth
*
Day
Month
Year
National Insurance Number
Address
*
Address line 1
Address line 2
City
County
Post code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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?
*
Please select
Yes
No
Nationality
Nationality
*
Please select
United Kingdom
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Have you been a resident in the UK/EU in the past 3 years
*
Please select
Yes
No
Country of residence prior to the past 3 years
*
Please select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Saint Martin
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
How many years did you live at this address for?
*
Education
Please select which of the following applies to you
*
Please select
I am no longer at high school/sixth form/college
I am at high school
I am at sixth form/college
I am home educated
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?
*
Please select
Year 12
Year 13
Course title
*
Course level
*
Please select
Diploma
AS Level
A Level
BTEC
Other
Diploma grade
*
Please select
Level 1
Level 2
Level 3
Technical Baccalaureate
AS Level grade
*
Please select
A*
A
B
C
D
E
A Level grade
*
Please select
A*
A
B
C
D
E
BTEC grade
*
Please select
Pass
Merit
Distinction
'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 ?
*
Please select
Yes
No
1. Maths Qualification
*
Maths
Maths Level
*
Please select
GCSE
Functional Skills
O Level
CSE
Other
Maths GCSE Grade
*
Please select
1
2
3
4
5
6
7
8
9
A
B
C
D
E
F
G
Maths Functional Skills Grade
*
Please select
Level 1
Level 2
Maths O Level Grade
*
Please select
A
B
C
D
E
Maths CSE Grade
*
Please select
1
2
3
4
5
Maths 'Other' Grade
*
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?
*
Predicted
Achieved
2. English Qualification
*
Please select
English Language
English Literature
English Level
*
Please select
GCSE
Functional Skills
O Level
CSE
Other
English GCSE Grade
*
Please select
1
2
3
4
5
6
7
8
9
A
B
C
D
E
F
G
English Functional Skills Grade
*
Please select
Level 1
Level 2
English O Level Grade
*
Please select
A
B
C
D
E
English CSE Grade
*
Please select
1
2
3
4
5
English 'Other' Grade
*
Please give details of the qualification Level and Grade
Is this qualification predicted or achieved?
*
Predicted
Achieved
3. Science Qualification
*
Please select
Science - Biology
Science - Chemistry
Science - Physics
Science - Combined
Science - Triple
Science Level
*
Please select
GCSE
Functional Skills
O Level
CSE
Other
Science GCSE Grade
*
Please select
1
2
3
4
5
6
7
8
9
A
B
C
D
E
F
G
Science Functional Skills Grade
*
Please select
Level 1
Level 2
Science O Level Grade
*
A
B
C
D
E
Science CSE Grade
*
1
2
3
4
5
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
Please select
GCSE
Functional Skills
O Level
CSE
Other
4th Qualification GCSE Grade
Please select
1
2
3
4
5
6
7
8
9
A
B
C
D
E
F
G
4th Qualification Functional Skills Grade
Please select
Level 1
Level 2
4th Qualification O Level Grade
A
B
C
D
E
4th Qualification CSE Grade
1
2
3
4
5
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
Please select
GCSE
Functional Skills
O Level
CSE
Other
5th Qualification GCSE Grade
Please select
1
2
3
4
5
6
7
8
9
A
B
C
D
E
F
G
5th Qualification Functional Skills Grade
Please select
Level 1
Level 2
5th Qualification O Level Grade
A
B
C
D
E
5th Qualification CSE Grade
1
2
3
4
5
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?
*
Please select
Yes
No
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
Phone
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