Crowther Hall, Hamilton Drive, Birmingham, B29 6AJ Tel: 0121 472 0726

Short Courses APPLICATION FORM

1.Course

Please list the course(s) you would like to study.

2. Name/Contact Details
3.Physical Disability / Learning Difficulty / Health

Do you have any physical disability, learning difficulty or health problem that might affect your studies or residential needs? If so, please give details:

4. Emergency Contact
5. Education and Training

Please list details below (most recent first) of qualifications you have gained. If you have not yet gained the award, please state in the Date of award column ’pending’ (add additional rows if necessary).

Name of institution and address Dates of attendance (From – To) Qualification, subject name and awarding body Date of award
  Add Row
6. Christian Experience
7. Referees
8. Criminal Convictions

BCC has a duty to ensure the safety and security of its students and staff. Please tick the relevant box below:

Do you have any criminal convictions?
14. Finance

Please remember that all applicants, including those from the UK and EU will be required to pay each semester's fees by the end of the first week of each semester. Overseas applicants requiring a study visa will be required to pay their fees in full before an offer letter can be issued.

15. Declaration

I confirm that the information given on this form is true, complete and accurate and that I have not withheld any information relevant to my application. I understand that in accordance with the Data Protection Act my information will be held electronically. I give my consent to the processing and storing of my data by Birmingham Christian College as detailed within the Student Privacy Notice. I understand that any offer of a place as a student received will be based on the information given in this application and that if I am found to have supplied false information, any such offer will be withdrawn.

Equal Opportunities Monitoring Information

Information on ethnicity and/or disability will not be used in reaching a decision on the outcome of your application.

Ethnic origin (please tick one box only)

Disabilities (tick all that apply)

Disabilities (tick all that apply)

you selected ‘Other’ please specify:

Finding out about Birmingham Christian College

How did you first learn about Birmingham Christian College (please tick)?

Additional Information