Home tel no:
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Date of birth:
Next of kin:
Next of kin Relation:
Next to Kin email address:
Next of kin contact number:
Secondary schools attended:
Arrow Vale High School
Bewdley High School & Sixth Form Centre
Bishop Milner Catholic School
Bishop Perowne C Of E College
Blessed Edward Oldcorne Catholic College
Bridgnorth Endowed School
Castle High School and Visual Arts College
Chadsgrove School (PRU)
Chantry High School
Chase High School
Christopher Whitehead Language College
De Montford School (formerley Evesham High)
Droitwich Spa High School
Dyson Perrins C of E High
Earls High School
Edgecliff County High School
Elmhurst School for Dance
Hagley Catholic High School
Hanley Castle High School
Haybridge High School
Holy Trinity International School
King Charles Ist School
Lacon Childe School
Leasowes Community College
Ludlow Church of England School
Newman RC School
North Bromsgrove High School
Nunnery Wood High School
Oldbury Wells School
Ounsdale High School
Pedmore Technology College
Pershore High School
Prince Henry's High School
Regency High School
Ridgewood High School
Rigby Hall School
Shelfield Community School
South Bromsgrove Community High School
St Augustine's Catholic High School
Stourport High School & Sixth Form Centre
Tenbury High School
The Coseley School
The Dormston School
The Ellowes Hall Sports College
The High Arcal School
The Hillcrest School & Community College
The Kings School
The Kingswinford School
The Wordsley School
Thorns Community College
Trinity High School and Sixth Form Centre
Tudor Grange Academy Centre
Vale of Evesham School
Waseley Hills High School
Windsor High School
Wolverley CE School
Wyre Forest School (was Stourminster School)
Enter School Manually
Have you studied Kidderminster College previously?
How did you find out about Kidderminster College?
Course you wish to apply for:
Access To Further Education Diploma Level 1 Pre Access To HE Diploma - Health Professionals Level 3 Access To HE Diploma - Health Professionals Level 2 Animal Care Diploma Level 1 Animal Care Diploma Level 2 Animal Care Diploma Level 3 Accounting & Business Diploma Level 2 Accounting & Business Diploma Level 3 Social Media For Business Diploma Level 3 Combined Health & Social Care & Childcare Diploma Level 1 Childcare Diploma Level 2 Childcare Diploma Level 3 Health & Social Care Diploma Level 2 Health & Social Care Diploma Level 3 Brickwork Diploma Level 1 Brickwork Diploma Level 2 Carpentry Diploma Level 1 Carpentry Diploma Level 2 Carpentry Diploma Level 3 Electrical Installation Diploma Level 1 Electrical Installation Diploma Level 2 Electrical Installation Diploma Level 3 Painting and Decorating Diploma Level 1 Painting and Decorating Diploma Level 2 Property Maintenance Diploma Level 1 Property Maintenance Diploma Level 2 Acting Diploma Level 3 Dance - IGNITE Dance Centre Diploma Level 2 Dance - IGNITE Dance Centre Diploma Level 3 Musical Theatre Diploma Level 3 Performing Arts Diploma Level 1 Performing Arts Diploma Level 2 Technical Theatre Stage Diploma Level 2 Technical Theatre Stage Diploma Level 3 Professional Media Production Diploma Level 2 Professional Media Production Diploma Level 3 (TV, Film & Radio) MAS Records Digital Music Production Diploma Level 3 MAS Records Artist Development Level 2 MAS Records Artist Development Level 3 BA (Hons) Creative Industries Top Up Level 6 Art & Design Diploma Level 3 GCSE English GCSE Maths Functional Skills Maths Functional Skills English Functional Skills IT Community Maths Community English Fashion, Clothing & Textile Design Diploma Level 3 Bridging Diploma Level 1 Vocational Studies Diploma Level 1 Land Based & Conservation Studies Diploma Level 1 Land Based & Conservation Studies Diploma Level 2 Digital Games Design & Development Diploma Level 2 Digital Games Design & Development Diploma Level 3 Hairdressing Diploma Level 1 Hairdressing Diploma Level 2 Hairdressing Diploma Level 3 Hairdressing- Salon Management Diploma Level 4 Hair & Media Make-Up Diploma Level 2 Hair & Media Make-Up Diploma Level 3 Beauty Therapy Diploma Level 1 Beauty Therapy Diploma Level 2 Beauty Therapy Diploma Level 3 Beauty Therapy - Massage Diploma Level 3 HND Early Education & Care Dance - HND Diploma Level 5 Computing - HNC Diploma Level 4 Computing - HND Diploma Level 5 HND Music Performance IT, Design & Workplace Skills Diploma Level 1 IT Digital Technicians Diploma Level 2 IT Digital Technicians Diploma Level 3 Computing With Programming & App Development Diploma Level 3 Auto Respraying Diploma Level 1 Auto Respraying Diploma Level 2 Motorcycle Maintenance & Repair Diploma Level 1 Motorcycle Maintenance & Repair Diploma Level 2 Motor Vehicle Transport Maintenance Diploma Level 1 Motor Vehicle Transport Maintenance Diploma Level 2 Public Services Diploma Level 2 Public Services Diploma Level 3 Sport Diploma Level 1 Sports Diploma Level 2 Sports Diploma Level 3 Equine Care Diploma Level 2 Equine Care Diploma Level 3 Travel and Tourism Diploma Level 2 Travel and Tourism Diploma Level 3 Not sure
Have you received any advice and guidance about your choice of course?
If you are uncertain about which course(s) you would like to study please contact our Learner Services Department on 01562 512 025 who will be happy to advise you.
What qualiﬁcations do you have (if known) or studying for?
If you have predicted grades please state these here.
Support required – all applicants to complete
We are committed to every learner at Kidderminster College, therefore we really want you
to tell us if you feel you may have support needs. We are here to help you achieve your
potential. Please tick all boxes that apply to you:
Do you have a disability?
We will approach your existing learning institution in order to ensure we provide the best
additional support for you.
Please let us know if you require any further interview support, eg. a signer, an accessible
room or other – please give details:
Have you had a learning mentor at school?
Do you have an Educational Health Care Plan (EHCP)?
Are you in care or have you been in care in the last 12 months?
Do you care for another person?
This information is requested to enable us to monitor the implementation of our Equal
Opportunities policy in accordance with the Race Relations Amendment Act using the
government classiﬁcation of ethnicity. Are you:
White – British
White – Irish
White – Any other White background
Asian or Asian British – Bangladeshi
Asian or Asian British – Indian
Asian or Asian British – Pakistani
Black or Black British – African
Black or Black British – Caribbean
Asian or Asian British – Any other Asian background
Mixed – White and Asian
Black or Black British – Other black background
Mixed – White and Black African
Mixed – White and Black Caribbean
Mixed – Any other mixed background
Prefer not to say
Not known/not provided
Have you been a full resident within the European Union throughout the last three years for
purposes other than study?
No If no, please enter current residential status and origin of passport: (Your application will
be reviewed by Learner Services.)
Interviews normally take place after 4pm during the week. Please list any dates you are unavailable to attend an interview (e.g. exams, holiday):
Course content is indicative and we reserve the right to make changes where necessary.
Please let us know if you require any further interview support, eg. a signer, an accessible room or other – please give details:
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