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Personal Details:
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Date of Birth: dd/mm/yyyy **
Age on 31st August 2013: **

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Please indicate the CELTA course you would be interested in: **
 June (intensive)  July (intensive)
 September - March (Part-Time)  February - June (Part-Time)
What year would you like to attend? **

What other languages do you know and what level of profeciency?


Why do you need this qualification?


Educational and vocational qualifications including any post school study:
Please state if O/A level, CSE, GCSE, RSA or City and Guilds, etc.
Subject / Institution
Exam Body
Grade
Dates



Please provide information about any teaching experience you may have, or other relevant experience (e.g. living abroad)



Additional Support:
Please tick any relevant boxes.
A member of the Learning Skills team will contact you to discuss you support needs.

Do you consider yourself to have a learning disability(L15)?   Yes No
Visual impairment and will need extra help
Hearing impairment and will need extra help
Disability affecting mobility
Other physical disability and will need extra help
Emotional/behavioural difficulties
Mental health difficulty
Temporary disability after illness (e.g. post-viral or accident)
Asperger's Syndrome
Asthma
Other medical condition which could affect my studies or exam arrangements (e.g. epilepsy, M.E., diabetes)
Please state:
Do you consider yourself to have a learning difficulty (L16)?   Yes No
Moderate learning difficulty
Severe learning difficulty
Dyslexia
Dyscalculia
Other specific learning difficulty
Autism spectrum disorder
Multiple learning difficulties

Data Protection Act

City of Bath College needs to process personal information about applicants in order to make admissions decisions to provide advice, guidance, education and training. In assessing applications information may be released to relevant government departments/agencies and Local Authorities.

Where an Application is not converted into an enrolment, paper records held on an applicant will be destroyed within 30 days of the stated date(s) of the course(s) to which this application relates. Data may be retained in an electronic format for analysis and future advice and guidance provision. Further details of the College's data protection arrangement are available on request.

I understand that the City of Bath College will need to process personal information in order to take admission decisions in accordance with the details set out above: **



A successful submission of this form will result in a thank you message and a copy of the completed form will be sent to the email address that you provided.

If you do not receive the thank you message, please refer to the list of fields that need to be completed. This will appear, in red, at the top of the form.

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