Students Application Form

PERSONAL DETAILS
SurName   First Name(s)*
Date Of Birth*
  Age
  Title
Current Address
PostCode   Home-Tel
E-Mail*   Mobile
COURSE INTERESTED IN
1.
2.
3.
QUALIFICATION COMPLETED
(Please enter all the four columns)
Date Subject Level Results
RESIDENCE STATUS
Have you been the an EU resident for the past 3 year?
In which country?  
If no give date of entry
Do you have UK/EU Passport?
Are you a Refugee/ Asylum Seeker?
ADDTIONAL LEARNING SUPPORT
Do you consider yourself to have learning difficulty?
Do you consider yourself to have disability?
EMERGENCY CONTACT
Name   
Tel         Relationship   
DECLARATION
I declare that I have checked the information given in this form and that to the best of my knowledge it is correct. I consent to this information being held on file under the terms of the Data Protection Act 1998. I agree to abide by the Muath Trust regulations.
 
 
      The Bordesley Centre, Stratford Road, Camp Hill, Birmingham B11 1AR.
   Tel:0121 753 0297 Email:education@muathtrust.org Website:www.muathtrust.org