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Course Fee: £152.00

Who Are You?
Legal First Name
Legal Last Name

Please provide us with a personal email address as this is will be how we provide important information to you such as details about your course interview and starting information for your course.

Email (enter again)
Contact Details

Please enter your postcode or partial address below:

Address 1
Address 2
About You
Date Of Birth

Is English Your First Language?

Normal Country of Residence

Have you lived within the European Economic Area (EEA) for 3 years or more?

EU Residence

European Economic Area includes: Austria, Belgium, Bulgaria, Croatia, Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, Switzerland and the UK


Do you consider yourself to have a Learning Difference OR have received additional support at school or in the work place? This might include help with reading, understanding, social interaction, visual/hearing impairments, and mobility difficulties.


If Yes, we will contact you to discuss your support requirements. Any information that you provide will be kept private and will not be passed to anyone without your prior consent.

Do you receive either of the following benefits: job seeker's allowance and/or employment support allowance (WRAG)?

Do you receive a state benefit (excluding child benefit) and intend to take this course to improve employment prospects?

What is your current employment status?

How many hours per week do you work?
How long have you been unemployed for?
Emergency Contact

Please provide the details of someone we can contact in case of an emergency.

Emergency Contact 1 *

Name Of Contact
Phone No

Emergency Contact 2

Name Of Contact
Phone No

I understand that by opting in to this data release, I am giving my permission for information on my application, performance and progression before and during my studies at Chichester College to be shared with the people specified. Personal information supplied on this form will be used to share details on your application, performance and progress at college and kept in accordance with current data protection legislation and in line with the college protection notice and policy on our website

Please tick to confirm you understand the above


Chichester College may contact you for marketing purposes. Please tick this box if you wish to receive such material from us.

The fee for this course is £152.00. Please click on the Submit button to submit your application and provide your payment details. Please be aware that you will be redirected to our payment provider, WPM, to make your payment.

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