Online Course Application Form Selected courses Award in Instructing Kettlebells Training Sessions L2 Part time day Starts 31 January 2020 at 09:15 + Add a Course Personal Information Title* Title Mr Mrs Miss Ms Dr First Name* Surname* Date Of Birth* National Insurance Number (Capitals, No Spaces) Ethnicity* English / Welsh / Scottish / Northern Irish / British Irish Gypsy or Irish Traveller Other white background White and Black Caribbean White and Black African White and Asian Other Mixed / multiple ethnic background Indian Pakistani Bangladesh Chinese Other Asian background African Caribbean Other Black / African Caribbean background Arab Other ethnic group Not known / not provided Nationality* Afghanistan Africa Not Otherwise Specified Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antarctica And Oceania Not Otherwise Specified Antigua And Barbuda Argentina Armenia Aruba Asia (except Middle East) Not Otherwise Specified Australia Austria Azerbaijan Bahamas, The Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia And Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Burma Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Caribbean Not Otherwise Specified Cayman Islands Central African Republic Central America Not Otherwise Specified Chad Channel Islands Channel Islands Not Otherwise Specified Chile China China (taiwan) Christmas Island Cocos (keeling) Islands Colombia Comoros Congo Congo (democratic Republic) Cook Islands Costa Rica Croatia Cuba Cyprus Cyprus (european Union) Cyprus (non-European Union) Cyprus Not Otherwise Specified Czech Republic Czechoslovakia Not Otherwise Specified Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Estonia Ethiopia Europe Not Otherwise Specified Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia, The Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island And Mcdonald Islands Honduras Hong Kong (special Administrative Region Of China) Hungary Iceland India Indonesia Iran Iraq Ireland Isle Of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao (special Administrative Region Of Chiina) Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Middle East Not Otherwise Specified Moldova Monaco Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North America Not Otherwise Specified Northern Ireland Northern Mariana Islands Norway Not Known Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn, Henderson, Ducie And Oeno Islands Poland Portugal Puerto Rico Qatar R?nion Romania Russia Rwanda Samoa San Marino Sao Tome And Principe Saudi Arabia Scotland Senegal Serbia And Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South America Not Otherwise Specified South Georgia And The South Sandwich Islands Spain Spain (except Canary Islands) Spain Not Otherwise Specified Sri Lanka St Helena St Kitts And Nevis St Lucia St Pierre And Miquelon St Vincent And The Grenadines Sudan Surinam Svalbard And Jan Mayen Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad And Tobago Tunisia Turkey Turkmenistan Turks And Caicos Islands Tuvalu Uganda Ukraine Union Of Soviet Socialist Republics Not Otherwise Specified United Arab Emirates United Kingdom United Kingdom Not Otherwise Specified United States United States Minor Outlying Islands United States Virgin Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Wallis And Futuna West Bank (including East Jerusalem) And Gaza Strip Western Sahara Yemen Yugoslavia Not Otherwise Specified Zimbabwe Do you have any unspent criminal convictions?* Yes No Have you been a UK or European resident for the past 3 years?* Yes No if no, please give your date of entry into UK or EU Do you have any disabilities or learning difficulties? Only required if you consider yourself to have a learning difficulty, disability or medical condition.(pick one or more where applicable) Emotional/behavioural difficulties Multiple disabilities Multiple learning difficulties Visual impairment Hearing impairment Disability affecting mobility Profound complex disabilities Social and emotional difficulties Mental health difficulty Moderate learning difficulty Severe learning difficulty Dyslexia Dyscalculia Autism spectrum disorder Asperger's syndrome Temporary disability after illness (for example post-viral) or accident Speech, Language and Communication Needs Other physical disability Other specific learning difficulty (e.g. Dyspraxia) Other medical condition (for example epilepsy, asthma, diabetes) Other learning difficulty Other disability Prefer not to say Not provided Emotional/behavioural difficulties Multiple disabilities Multiple learning difficulties Visual impairment Hearing impairment Disability affecting mobility Profound complex disabilities Social and emotional difficulties Mental health difficulty Moderate learning difficulty Severe learning difficulty Dyslexia Dyscalculia Autism spectrum disorder Asperger's syndrome Temporary disability after illness (for example post-viral) or accident Speech, Language and Communication Needs Other physical disability Other specific learning difficulty (e.g. Dyspraxia) Other medical condition (for example epilepsy, asthma, diabetes) Other learning difficulty Other disability Prefer not to say Not provided Please select current or previous school attended? Belmont School Community Arts College Bishop Barrington School Broom Cottages Carmel School & 6th Form Durham 6th Form Centre Durham Community Business College for Technology and Enterprise Durham Gilesgate Sports College - Gilesgate Durham Johnston Comprehensive School Education Village Ferryhill Business & Enterprise College Framwellgate School - Framwellgate Moor Greenfield School and Community Arts College Haughton Academy Hummersnott Academy Hurworth School King James I Academy Longfield Academy Murphy Crescent School Not Known Other or Not provided Parkside Academy Queen Elizabeth 6th Form Sedgefield Community College Spennymoor Comprehensive St Aidan's C of E Academy St John's Catholic Academy St Leonards Catholic School Staindrop School Business & Enterprise College Sunnydale Community College Teesdale School The Meadows School The Oaks School Timothy Hackworth School Tudhoe Grange Comprehensive (St Charles) Walworth School Warwick Road School Whitworth Park Academy Windlestone Hall School Wolsingham School & Community College Woodham Academy Wyvern Academy Have you had any extra time or other concessions in Exams? maximum length of 250 characters. Contact Information Email* Telephone* (11 Digits) Mobile (11 Digits) Home Address Address 1* Address 2 City/Town* County* Country* Post Code* Number of Years in Current Address* Enter in years. Put 0 if less than one year. Emergency Contact Details First Name* Surname* Telephone* (11 Digits) Extra details How did you hear about us?* College venue Opening evening Prospectus Leaflet/newsletter School Internet/website Email Facebook Twitter LinkedIn SMS/Text Word of mouth TV/Radio Newspaper What interests you about this course/s? maximum length of 250 characters Qualifications Please state any qualifications you have achieved (or are expected to achieve). add qualifications by completing the fields below and then clicking the add button. Subject Grade Date Awarded * ** *A *B *C *D *E *F *G PA ME DS DS DS DS 9 8 7 6 5 4 3 2 1 Have you achieved? GCSE Maths A* - C or Grade (9-4) Yes No GCSE English A* - C or Grade (9-4) Yes No Declaration I declare that to the best of my knowledge the information given above is correct and that if accepted, I agree to comply with the College rules and regulations. I agree to Bishop Auckland College processing the information contained on this application form. Please note that by completing this form your details will be held on the College database, in accordance with the Data Protection Act 1998, and will be used for administration purposes. As part of our Admissions process we will send you information and communications relating to your application and admissions.