Application for Admission to William Morris College

Application for Admission to William Morris College

Preferred Start Date………………………………………….…..

Residential/Day Placement……………………………….….

Course applyingfor :……………………………………….…….

FOR INTERNAL USE ONLY:
Independence and Vocational skills training (Term time only)
Independence Plus and Using Employability Skills (Term time only)
Extended Transition Programme
(52 Week Residential Placement)
Student Details
Surname: / First name:
Date of Birth: / Male/Female: / N.I.Number:
Disability/Diagnosis:
Ethnicity Code: (see attached list) / Religion:
Home address:
Post code:
Parent/Carer Details
Name:
Address: (if different from above)
Post code:
Telephone: / Mobile:
Email address:
Parent/Carer Details
Name:
Address:(if different from above)
Post code:
Telephone: / Mobile:
Email address:
Social Worker
Name:
Address:
Post code:
Telephone: / Mobile:
Email address:
Prospects/Connexions/Careers Wales/Personal Advisor
Name:
Address:
Post code:
Telephone: / Mobile:
Email address:
Current school/provision
Name of school:
Address:
Post code:
Contact Name:
Telephone: / Mobile:
Email address:
Other useful contact details i.e. learning disability nurse
Name:
Role:
Address:
Post code:
Telephone: / Mobile:
Email address:
Please state how you think the course applying for will benefit the young person?
Long term goals and aspirations (if known):

Applicants who are currently attending William Morris College and wish to apply for a new course need only complete the remainder of the form where the college have not been notified of changes.(Please sign and date the form at the end)

Medical/Health Needs
Specific Health Needs (e.g. mobility aides/equipment needed)
Current Medication:(e.g. Type/reason/last medical review)
Other medical needs:(e.g. regular contact with health professionals such as Occupational Therapy programme)
Date of the last hearing test and were any problems detected?
Date of the last eye test and were any problems detected?
Allergies:
Personal History
Early Years Development :
Significant Recent Developments:

In order for us to identify if William Morris House can meet the prospective student’s needs please comment on the following areas in as much detail as you can. Please include the level of support the student need as well as their willingness to be supported.

Communication
Does the student have a Speech and Language Therapy Programme?
(Please attach) / Yes/No
Preferred means of communication: (verbal/signing/visual)
Level of Understanding:
(answering questions/ following direction)
Social Use of Language:
(participate in conversation/social rules)
Ability to express or make needs known:
Emotional/Behavioural Development
Does the student have a Behaviour Management Plan?
(Please attach) / Yes/No
Types of behaviour demonstrated: (include any challenging behaviours/self-harming etc.)
Likes/Dislikes: ( include fears/phobias)
Dependency on structure or routine
Response to direction/authority
Relationships/Behaviour towards children:
Triggers to behaviours:
Coping/calming strategies:
(processing time/ preparation for changes)
Personal Care needs
Does the student have a Personal care plan?
(Please attach) / Yes/No
Toileting
Washing/Bathing
Eating
Dressing
Sleeping
Coping with Periods
Cutting hair/nails
Coping with Shaving
Independence
Road Sense
Attitude to work
Motivation
Shopping
Mobility
Personal Safety
Ability to occupy self
Household Tasks
Social Relationships- how does the young person relate to the following groups?
Relationship with family (Immediate & extended)
Friendship groups
Positions of authority
Strangers
Areas of vulnerability
* Sexualised behaviours/awareness / * please continue on a separate confidential sheet if necessary
Educational Information
Does the student have a Statement of Educational Need/recent annual review report/ILP?
(Please attach) / Yes/No
Literacy skills
Numeracy skills
Motor skills
Attitude to work
Learning styles
Additional Information
If you feel you would like to add any further information please do so here
Form completed by:
Signed: / Date:
Print name:
Student name:
Ethnicity Codes
White
31 / English / Welsh / Scottish / Northern Irish / British
32 / Irish
33 / Gypsy or Irish Traveller
34 / Any Other White background
Mixed / Multiple ethnic group
35 / White and Black Caribbean
36 / White and Black African
37 / White and Asian
38 / Any Other Mixed / multiple ethnic background
Asian / Asian British
39 / Indian
40 / Pakistani
41 / Bangladeshi
42 / Chinese
43 / Any other Asian background
Black / African / Caribbean / Black British
44 / African
45 / Caribbean
46 / Any other Black / African / Caribbean background
Other
47 / Arab
98 / Any other ethnic group
99 / Not known/not provided
Safeguarding Issues
If there are any specific safeguarding issues which you feel relevant to the application please complete on this form and place in envelope marked confidential.
Form completed by:
Signed: / Date:
Print name:
Student Name
Further confidential information
If there are any specific issues which you feel relevant to the application please complete on this form and place in envelope marked confidential.
Form completed by:
Signed: / Date:
Print name:
Student Name

PERSONAL FINANCES

As a student at William Morris College you may be eligible for additional entitlements such as a bursary or free meals. (Not applicable to applicants for the extended Transition Programme)

We have enclosed leaflets outlining the criteria for these benefits

However we are happy to assess your eligibility for these entitlements for you, in order to do so we need to know certain information related to the students own benefits and also the parents financial circumstances.

We understand that this information is personal and will be dealt with sensitively and confidentially.

Student Name:
Date of Birth:
Age on 31st August of the year you wish to start the placement
Student benefits:

Does he/she receive Income support?YES* / NO

Does he/she receive both Disability Living

Allowance & Employment Support Allowance?YES* / NO

Does he/she receive a Universal Credit paymentin their own name?YES* / NO

Does he/she receive Employment Support

Allowance and a Personal Independence
Payment in their own name?YES* / NO

Is he/she a ‘looked after child’

/ YES* / NO
YES* / NO
YES* / NO
YES* / NO
YES* / NO
Parental circumstances:

Are you in receipt of Income support?YES* / NO

Are you in receipt of income-based jobseekers allowance

Are you in receipt of income related Employment and Support Allowance (ESA)

Are you in receipt of support under part V1 of the immigration and asylum act 1999

Are you in receipt of the guarantee element of State Pension credit

Are you in receipt of Child Tax Credit with an annual household income of less than £16,190 and do not get Working Tax Credit

/ YES* / NO
YES* / NO
YES* / NO
YES* / NO
YES* / NO
YES* / NO

We will assess the information you have provided and send you an application form if we think you are eligible for either of these benefits.

Please note you will be required to provide evidence of your benefits to support your application

If you wish to discuss this further please contact the college direct on 01452 824025 and our admissions team or Finance Co-ordinator will be please to help you.

Registered company details: