LSBL

New Application

Application

Course Applying For

Campus

Intake

Year of Course

Programme/Course

Study Preference

Route

Personal Information

First Name

Last Name

Date of Birth

Email Address

Country of Birth

Current National

Sex

Ethnicity

Mobile Number

Religion

Current/Termtime address

Address Line 1

Address Line 2

City

State

Zip Code

Country

UK port entry date (* for CCCU applicants if Country of birth is not UK)

National Insurance Number (* for NCG applicants )

Highest qualification on entry

Qualification

Area of qualification

Grade / Result

Year of completion

Country of issue

Disabilities

Two or more impairments and/or disabling medical conditions

A specific learning difficulty such as dyslexia dyspraxia or AD(H)D

A social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder

A long standing illness or health condition such as cancer HIV diabetes chronic heart disease or epilepsy

A physical impairment or mobility issues such as difficulty using arms or using a wheelchair or crutches

Deaf or a serious hearing impairment

Blind or a serious visual impairment uncorrected by glasses

Disability impairment or medical condition that is not listed above

A mental health condition such as depression schizophrenia or anxiety disorder

No known disability

Personal Statement (minimum 250 words)

Criminal conviction

It is mandatory to complete this section. If it is not complete the application will be invalid and will be declined.

Have you ever been convicted by the courts cautioned, reprimanded, or given a final warning by the police? Please give details of offences, penalties, and dates in the table below. * (Note that the post you have applied for is exempted under the Rehabilitation of Offenders Act (Exceptions Order) 1974, which means that all convictions, cautions, reprimands, and final warnings on your criminal record need to be disclosed.)

Details of judgment or civil penalty

Have you ever been disqualified from working with children or vulnerable adults or subject to any other sanctions imposed by a regulatory body?

Details of disqualification or sanctions by a regulatory body

Are you registered with the Disclosure and Barring Service (DBS) Update Service?

Details of Disclosure and Barring Service (DBS) Update Service