PERSONAL DETAILS

First Name

Middle Name

Last Name

Date of Birth
(DD/MM/YYYY)

Nationality

APPLICATION FORM

Gender

CONTACT DETAILS

Address 1

Address 2

Address 3

City

Post Code

Country

Home Phone

Mobile Phone

e-Mail Address

Skype ID

COURSE DETAILS

If "Other",
Please Specify

Course Mode

Preferred
Start Date

Special Needs

Course Title

ACADEMIC HISTORY

Qualification

College/University

Year(s)

Qualification

College/University

Year(s)

Qualification

College/University

Year(s)

EMPLOYMENT HISTORY

Position

Employer

Year(s)

Position

Employer

Year(s)

Position

Employer

Year(s)

REASON FOR APPLICATION

Please, tell us a little about yourself, why you want to do this course
and what made you choose Atkins Academy.

ENGLISH LANGUAGE PROFICIENCY

Qualification Type

Score/Grade

Year

Body

IMMIGRATION DETAILS (Non-UK nationals only)

Do You need a
visa to study
in the UK?

Do You Hold
a Visa Now?

Passport No

Passport
Expiry Date

Date of
UK Entry

Name of Your
Current Sponsor

Visa Valid From

Visa Valid To

REFERENCES (Degree Students Only)

Please, provide the names and contact details of two references.
One must be academic and the other professional.

Reference 1

Relationship
to You

Address

Phone

e-Mail

STUDENT DECLARATION

The aim of the admissions process is to select students who have the ability and motivation
to benefit from the programmes they intend to follow and who will make a contribution
to the life of the Academy.

The process takes place within the context of the Academy’s Equal Opportunities policy which
expresses the Academy’s commitment to a comprehensive policy of equal opportunities
for students in which individuals are selected and treated on the basis of their relevant merits
and abilities and are given equal opportunities within the Academy.

The aim of the policy is to ensure that no prospective student or enrolled student should receive
less favourable treatment on any grounds which are not relevant to academic ability or
attainment. It is, however, important that these aims are achieved without prejudice to the safety
and wellbeing of other members of the Academy community.

Rehabilitation of Offenders Act 1974
You are asked to state whether or not you have any relevant criminal convictions. These are only
those convictions for offences against a person, whether of a violent or sexual nature, and
convictions for offences involving unlawfully supplying controlled drugs or substances where the
conviction concerns commercial drug dealing or trafficking. Convictions that are spent (as defined
by the Rehabilitation of Offenders Act 1974) are not considered to be relevant and you should
not reveal them.

I have a relevant criminal conviction that is not spent.


I am serving a prison sentence for a relevant criminal conviction.

I undertake to be bound by all the rules and regulations in force under the Articles of
Quality Control of Atkins Academy.

I confirm that the information given in my application form is true, complete and accurate,
and that no information requested or other material information has been omitted.

PERSONAL STATEMENT

I accept that, if I do not comply with these requirements, Atkins Academy
may cancel my application and any subsequent offer and I shall have no claim
against Atkins Academy in relation thereto.

Reference 2

Relationship
to You

Address

Phone

e-Mail