Students Application Form
PERSONAL DETAILS
SurName
First Name(s)
*
Date Of Birth
*
Age
Male
Female
Title
------Select------
Mr
Mrs
Ms
Other
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?
Yes
No
In which country?
If no give date of entry
Do you have UK/EU Passport?
Yes
No
Are you a Refugee/ Asylum Seeker?
Yes
No
ADDTIONAL LEARNING SUPPORT
Do you consider yourself to have learning difficulty?
Yes
No
Do you consider yourself to have disability?
Yes
No
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.
Agree
The Bordesley Centre, Stratford Road, Camp Hill, Birmingham B11 1AR.
Tel:0121 753 0297 Email:education@muathtrust.org Website:www.muathtrust.org