APPLICATION FORM
SURNAME TITLE
FORENAME  
MIDDLE
NAME		  
DATE OF
BIRTH		   AGE 1st SEPT GENDER
HOME
ADDRESS
POSTCODE  
EMAIL  
MOBILE LAND LINE
NATIONALITY   ETHNIC ORIGIN
WHAT KIND OF COURSE ARE YOU
INTERESTED IN?
DO YOU HAVE A MEDICAL CONDITION/DISABLEMENT?  
NAME OF SCHOOL/COLLEGE ATTENDED IN PAST 12 Months
HIGHEST LEVEL OF QUALIFICATION ALREADY HELD
IF YOU ARE CLAIMING NON PAYMENT OF FEES, PLEASE COMPLETE THIS SECTION
Aged 16-18 (under 19 as at 31st August)
In receipt of Income Support*
In receipt of Disability Working Allowance*
In receipt of Working Tax Credit* (subject to LSC Income Calculation Criteria)
Unwaged Dependants of those listed above*
In receipt of Job Seekers Allowance*
Adult Basic Education (Lit, Num, GCSE Engl., GCSE Maths)
  * Proof of benefit will need to be provided
The LSC also needs to gather information regarding Learner Background.
If you think you fit into any of the following areas, please indicate in the appropriate boxes.
01- Homeless   02- Ex-offender   03- 13-17 year old in danger of
school exclusion
04- Refugee 05- Drug or alcohol misuse 06- Returner to the labour market
07- People living in rural areas 08- Lone parent 97- Other
  Yes I have read the Terms of Agreement
For help with completing this form Telephone 01754 610620
Skegness College is registered under the Data Protection Act and collects information about prospective
learners for legitimate purposes only, in accordance with the Data Protection Act 1988.