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ACTIVE Application

Application Form

Thank you for applying to Addict Dance Academy. Please complete all sections of this form and select SUBMIT when you are finished.

PLEASE SELECT THE COURSE YOU WISH TO APPLY FOR

PERSONAL DETAILS

PLEASE SELECT THE COURSE YOU WISH TO APPLY FOR

BTEC EXTENDED DIPLOMA IN PERFORMING ARTS (DANCE) (LEVEL 3)

BTEC EXTENDED DIPLOMA IN PERFORMING ARTS (MUSICAL THEATRE) (LEVEL 3)

BTEC HIGHER NATIONAL DIPLOMA IN PERFORMING ARTS (DANCE) (LEVEL 4+5)

BTEC HIGHER NATIONAL DIPLOMA IN PERFORMING ARTS (MUSICAL THEATRE) (LEVEL 4+5) NEW

BA HONS DANCE (LEVEL 6) TOP UP

TITLE

Mrs

Miss

Other

FORENAME

SURNAME/FAMILY NAME

DATE OF BIRTH

Do you know your National Insurance Number?

Yes

NATIONAL INSURANCE NUMBER

PERMANENT ADDRESS

Address

Address Line 1

Address Line 2

City

County

Post Code

Country

Do you live at a different address during term time?

Yes

Address

Address Line 1

Address Line 2

City

County

Post Code

Country

HOME TELEPHONE

MOBILE TELEPHONE

EMAIL ADDRESS

ETHNICITY

I would describe my ethnic origin as:

ENGLISH/SCOTTISH/WELSH/ NORTHERN IRISH/BRITISH

IRISH

GYPSY OR IRISH TRAVELLER

OTHER WHITE BACKGROUND

INDIAN

PAKISTANI

BANGLADESHI

CHINESE

OTHER MIXED BACKGROUND

WHITE AND BLACK CARIBBEAN

WHITE AND BLACK AFRICAN

WHITE AND ASIAN

OTHER MIXED BACKGROUND

AFRICAN

CARIBBEAN

OTHER BLACK/AFRICAN/CARIBBEAN BACKGROUND

ARAB

ANY OTHER ETHNIC BACKGROUND

UNKNOWN/NOT PROVIDED

DISABILITY OR LEARNING DIFFICULTIES

DO YOU HAVE A DISABILITY?

Yes

DISABILITY

MULTIPLE DISABILITIES

BLIND OR VISUALLY IMPAIRED (little or no sight)

DEAF OR HEARING IMPAIRED (use a hearing aid or sign language

DISABILITY AFFECTING MOBILITY (e.g. wheelchair user)

EMOTIONAL/BEHAVIORAL DIFFICULTIES

MENTAL HEALTH DIFFICULTY (please state)

TEMPORARY DISABILITY OR ILLNESS (e.g. accident)

PROFOUND COMPLEX DIFFICULTY

ASPERGERS SYNDROME

OTHER PHYSICAL DISABILITY

OTHER MEDICAL CONDITION (e.g. epilepsy, asthma, diabetes)

OTHER (please state)

OTHER

DO YOU HAVE A LEARNING DIFFICULTY?

Yes

LEARNING DIFFICULTY

MODERATE LEARNING DIFFICULTY

SEVERE LEARNING DIFFICULTY

DYSLEXIA (difficulty with words)

DYSCALCULIA (difficulty with numbers)

AUTISM SPECRTUM DISORDER

OTHER SPECIFIC LEARNING DIFFICULTY (please state)

OTHER (please state)

OTHER

DO YOU NEED ANY SUPPORT AT INTERVIEW STAGE?

Yes

If YES please give details

DO YOU HAVE A STATEMENT OF SPECIAL EDUCATION NEEDS?

Yes

If YES please give details

ADDITIONAL DETAILS

DO YOU HAVE ANY UNSPENT CRIMINAL CONVICTIONS, INCLUDING INTENSIVE SUPERVISION AND SURVEILLANCE PROGRAMME (ISSP) OR DRUG TREATMENT AND TESTING ORDER (DTTO)?

Yes

PLEASE GIVE THE NAME OF THE LAST SCHOOL OR COLLEGE YOU ATTENDED OR ARE STILL ATTENDING

NAME OF EMERGENCY CONTACT

EMERGENCY CONTACT NUMBER

PERSONAL STATEMENT

Please complete the following questions:

WHY DO YOU WANT TO STUDY THIS COURSE?

HOW DO YOU THINK THIS COURSE WILL HELP YOU IN YOUR FUTURE PLANS OF EMPLOYMENT/EDUCATION?

DO YOU HAVE ANY PERFORMANCE EXPERIENCE?

ARE YOU CURRENTLY STUDYING ANY QUALIFICATIONS YOU ARE YET TO RECEIVE GRADES FOR?

Yes

HOW MANY QUALIFICATIONS ARE YOU CURRENTLY STUDYING?

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Predicted Grade

Date to be taken

Length of Study (Years)

Please add details of the remaining qualifications you are currently studying

TELL US ABOUT YOUR PREVIOUS QUALIFICATIONS (FOUNDATION DEGREE’S, HND’S, GCSE’S, A-LEVELS, BTECS ETC)

HOW MANY PREVIOUS QUALIFICATIONS DO YOU HAVE?

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Examining Board e.g. Edecel

Subject e.g. Maths

Level e.g. GCSE

Grade Achieved

Date taken

Length of Study (Years)

Please add details of the remaining qualifications you have completed

WHERE DID YOU HEAR ABOUT US?

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