JCC ADULT LEARNING APPLICATION FORM
Please use this form to make an initial application to one of our courses.  Enrolment onto any 
course will be subject to availability and an initial assessment.
Email *
First name *
Last name *
Date of Birth *
MM
/
DD
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YYYY
Are you over 19 years of age? *
First Line of address (e.g house number and road name) *
Second line of address (e.g area) *
Postcode *
Contact number *
Do you have a National Insurance number (NINO)? *
Have you been living in the UK for more than 3 years? *
If you have answered NO to the above question, from which country have you come to the UK?
Please select your employment status. *
Please list the highest current UK qualification you have including the level of the qualification(s) and the date taken.  (For example: ESOL E1 passed 2018)
Please list your highest grade in English and Maths.
Please tell us which course(s) you are interested in doing with JCC Adult Learning.

Please select 3 options only.
 *
Required
If you selected 'other' then please tell us which course you are interested in doing?
Which centre would you like to study at? *

Do you consider yourself to have a special educational need or disability? If so, please indicate below the nature of your difficulty. It would be beneficial to bring relevant evidence of this to your interview/assessment so this can be considered and a consultation with the Inclusive Learning Support Team can take place about how best to meet your needs during your studies:

If selected other medical condition above please specify below:
Any further information in support of your application:
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