West Highland College UHI Is a Company Limited by Guarantee (SC153921) with Charitable

West Highland College UHI is a company limited by guarantee (SC153921) with charitable status (SC024193)

ENROLMENT FORM 2017/18
Are all sections complete?
Evidence checked & attached?
Has the form been signed by both student and enrolling staff? (4 Checks) / Staff initials
Enrolling Centre:
/ STUDENT ID NUMBER / (Admin only)
SITS / (Admin only)
This enrolment form will only take a few minutes to complete and will help us to make sure that you are properly accredited with your qualifications on successful completion of your course.
Please complete all parts of the form and, if you are unsure about any part, a member of College staff will be pleased to help you.
SOME GUIDELINES
1.  Please tick the answer that applies to you, where asked.
2.  Where there is no tick box, please write the relevant information in the space provided.
3. Please ensure Declaration is signed by Student and Lecturer before Submission.
1. Personal Details TO BE COMPLETED BY STUDENT
Surname:
(BLOCK CAPITALS) / Forenames:
(BLOCK CAPITALS)
Title:
(Tick) / Mr / Mrs / Miss / Ms / Date of Birth: / D / D / M / M / Y / Y / Sex:
(Tick) / Male / Female / Other
Previously Registered with SQA? (Tick) Yes□ No□ / SQA Candidate Number:
Home address: / Term time address: (if different from home address)
Postcode: / Postcode:
Telephone: / Term Time Telephone:
Mobile No.: / E-mail address:
How long have you been resident in Scotland? Years Months
Emergency Contact Please give the name and telephone number of someone the College could contact in the event of an emergency.
Surname:
(BLOCK CAPITALS) / Forenames:
(BLOCK CAPITALS)
Emergency Telephone Number: / Relationship to you? (Tick below)
Parent □ Guardian□ Spouse/Partner□ Other□
2. Course Details - shaded areas to be completed by college staff
Course Name (please use the correct title - as seen on the WEB Staff Area) / Student Start Date: / Expected End Date:
Course Code: from WEB Staff area / Group Award Code: (must be completed for all students studying for a group award) / Blk/Occ (SITS use only) / ILA Scotland Booking Date: (if appropriate)
3. Other Details TO BE COMPLETED BY STUDENT
Ethnic Origin Please Tick One:
Scottish 13□ / English 17□ / Welsh 18□ / Northern Irish 15□
Irish 12□ / British 11 □ / Gypsy 16□ / Polish 20□
Other White Background 19□ / Any Mixed Background 49□ / Indian 31□ / Pakistani 32□
Bangladeshi 33□ / Chinese 34□ / Arab 50 □ / Other Asian Background 39□
Caribbean 21□ / African 22□ / Other Black Background 29□ / Other Background 80□

Permanent Home Location Please Tick one:

Area Code Number Area Code Number Area Code Number
Aberdeen City 161 East Renfrewshire 173 Orkney Islands 184
Aberdeenshire 162 Edinburgh, City of 174 Perth and Kinross 185
Angus 163 Falkirk 175 Renfrewshire 186
Argyll & Bute 164 Fife 176 Scottish Borders 165
Clackmannanshire 166 Glasgow City 177 Shetland Islands 187
Dumfries and Galloway 168 Highland 178 South Ayrshire 188
Dundee City 169 Inverclyde 179 South Lanarkshire 189
East Ayrshire 170 Midlothian 180 Stirling 190
East Dunbartonshire 171 Moray 181 West Dunbartonshire 167
East Lothian 172 North Ayrshire 182 West Lothian 191
Na h-Eilean Siar 192 North Lanarkshire 183

Country of Nationality Please Tick one:

Scotland XH□ / England XF□ / Wales XI □ / Northern Ireland XG□ / Channel Islands XL□
Isle Of Man IM□ / Eire IE□ / Poland PL□ / Czech Republic CZ□ / China CN□
India IN□ / Pakistan PK □ / If not listed please state:

Disabilities Do you have a disability which could cause you difficulty during your course? Please Tick:

No Disability A□ / Dyslexia G□ / Blind/partially sighted C□ / Deaf/hearing impairment D□
Wheelchair user/mobility difficulties H□ / Mental health difficulties F□
An unseen disability not listed above, e.g. diabetes, epilepsy, asthma E□
A social/communication impairment, e.g. Asperger’s B□ / A disability not listed I□ / Information refused R□
Would you like Student Services to contact you to arrange additional support, including learning support?
Yes □ No □

Religion, Religious denomination or body Please Tick One:

Christian: Protestant□ / Christian: Roman Catholic□ / Christian: Other □
Muslim□ / Buddhist□ / Sikh□ / Jewish□
Hindu□ / Another religion or body□ / No Religion □ / Prefer not to say□
Sexual Orientation Please Tick One:
Bisexual □ / Gay Man□ / Gay Woman/Lesbian□ / Heterosexual (straight)□ / Prefer not to say □

Groups of Specific Interest Would you class yourself as belonging to any of the following groups? Please Tick One:

Care-experienced AA□ Are you currently in care? (Please tick) Yes □ No □
Person Granted Discretionary Leave to Remain AJ□ / Iraqi Direct Entry Assistance Scheme AD□ / Refugees AG□
Person Granted Humanitarian Protection AH□ / Bereaved Children Scheme AC□ / Asylum seekers AF □
Syrian Vulnerable Persons Relocation Scheme(VPRS) AK□ / Profound and Complex Needs AE□
Veterans/Early Service Leavers □ / None □

Caring Responsibilities

Do you have unpaid caring responsibilities for a family member or friend who is ill, frail, disabled or has a mental health or addiction problems? Yes □ No □ If Yes, Who do you Care For? Tick below:
Disabled Child/Children under 18 □ / Child/Children under 18 □
Adult(s) 18 and over □ / Prefer not to say □

Qualifications Enter number of each qualification held

National 5, Standard Grade, SCE, GCE or GCSE
Grades A-C/1-3
Grades D-E/4-5 / Highers
Bands A-C / A Levels
Grades A-E / SQA Unit Passes
Other Qualifications Tick highest level
Degree 01□ / Membership of professional body 02□ / HND or equivalent 03□
GSVQ/GNVQ level 4 and above 05□ / HNC or equivalent 06□ / Other advanced qualifications 07□
CSYS / Advanced Higher 08□ / SVQ/NVQ level 3 09□ / Access 3/Foundation Standard Grade 10□
Access to University Course 11□ / SVQ level 2 / Int 2 / Credit SG 12□ / Access 2 13□
SVQ level 1 / Int 1 / General SG 14□ / Access 1 15□ / Standard / Higher Grade 99□
Ordinary/Scottish National Diploma 16□ / Ordinary/Scottish National Certificate 17□ / Adv Higher/Scottish Baccalaureates 26□
National 1 20□ / National 2 21□ / National 3 / SfW National 3 22□
National 4 / SfW National 4 23□ / National 5 / SfW National 5 24□ / SfW Higher 25□
4.Funding Details TO BE COMPLETED BY STUDENT
School Information required for Students Under 20 at time of enrolment:
Current/Previous School Write Name of school

Student Category Please tick one category which applies to you

Primary School Pupil 17□ / Winter Leaver 21 □ / Full-time College Based 10□
School based S1 15□ / Scottish wider access programme 05□ / Permanent or temporary employment 11□
School based S2 16□ / Other access course (not SCE/GCE) 06□ / Reg. Unemployed –jobseeker allowance 12□
School based S3 01□ / Students on European Exchange 07□ / Reg. Unemployed –no jobseeker allowance13□
School based S4 02□ / Skillseeker, New Deal, Modern Apprentice 08□ / Not registered Unemployed but not working 14□
School based S5 03□ / Other LEC sponsorship e.g. TFW 09□ / Retired 18□
School based S6 04□ / Migrant Worker 20□
School pupil S1-S6 but not on a school link programme 19□
Publicity Permission
West Highland College UHI may wish to use photographs or video film taken during your study, in publicity displays, promotional material and on the college website and social media now or in the future.
I do / do not (please circle one) give West Highland College UHI the right to use, reproduce and distribute my photograph or image, for the purposes mentioned above.
Source of Finance How are you paying for your studies? Please tick:
Failure to supply the correct ‘Source of Finance’ details may result in you being invoiced
Self-Financing Please add details over the page F14□ / Employer Please add details over the page F10□
FW Full-time Non Advanced F22□ / ILA please supply ILA number______and copy of ILA letter F17□
FW Special Needs (DPG18) F33□ / College Fee Waiver Exemption Form must be completed and attached F26 □
FW School Pupil F42□ / Skill Seeker, Modern App. F05 □ / LEA (England, Wales or N. Ireland) F03□
European Union Funding F08□ / Training for Work F06 □ / Public Bodies (not specified elsewhere) F07 □
Rest Of UK (RUK) F54 □
5. Payment of Course

If you ticked Employer as paying for your course fee please complete the details below and supply purchase order number or letter

Employer Name and Address:
______
______
______
______/ Account to be sent to:
Name:______
Address:______
______
Tel. No.:______
Purchase Order Number:______
If you ticked Self Financing please circle which method of payment you have used
Invoice Switch
Cash Credit Card
Cheque
DECLARATION
West Highland College and The University of the Highlands and Islands (UHI), The University of the Highlands and Islands Development Trust and Academic Partners are registered under the 1998 Data Protection Act. The personal data that you supply is held and processed by West Highland College and UHI and/or the academic partner(s) which constitute the University of the Highlands and Islands (UHI). By agreeing to this declaration you consent to these bodies holding and processing your personal data for the purposes of complying with the statutory obligation to provide information to a number of official agencies, as well as for their own administrative, business and research activities, the publication of graduation lists and in order to communicate with and provide services to UHI alumni. Where required, your information may be supplied to other official agencies and awarding bodies e.g. The Scottish Funding Council (SFC); Scottish Qualifications Authority (SQA); City and Guilds (C&G). We may also share information with Skills Development Scotland (SDS). Should you leave your course prior to its completion, SDS may contact you to offer advice and support should you wish. It will also allow SDS to conduct research and analysis into student destinations.
Your personal data will also be used for the purposes of providing references, if we are asked to so do, and information on your progress may be disclosed to an organisation providing you with financial support (e.g. your employer), unless you advise us otherwise in writing addressed to the data controller. We may also provide confirmation of your student status to your local authority for the purposes of Council Tax relief, and to the Department for Work and Pensions. Details of your name, award and enrolling and/or host academic partner may be published in graduation lists (including lists supplied to the media) unless you advise us otherwise in writing addressed to the data controller. By signing this declaration you agree to the processing of your personal data as described above. You also confirm that, as far as you are aware, the enrolment particulars are correct and that you have read and agree to abide by the regulations of the college and/or UHI as supplied to you. Failure to comply with regulations may result in disciplinary action and ultimately possible exclusion from your studies. West Highland College & UHI are entitled to suspend or expel a student from a course, where it is considered that you pose a risk to the welfare of staff and/or other students. You also agree to accept responsibility for fees due if someone who has undertaken to pay them on your behalf fails to do so. You understand that you may incur additional charges if any outstanding debt is transferred to a debt Recovery Agent.
By enrolling as a West Highland College student, you agree that any award for which you study may be awarded by West Highland College or by another awarding body, at the sole discretion of West Highland College UHI.
Signed:
Student / Date:

Enrolling staff must check this form for completeness and sign

Signed:
Enrolling Lecturer Signatory / Date:

If Certified as eligible for Fee Waiver – please attach documentary evidence.

ALL ECDL enrolments: Proof of learner ID has been verified by the enrolling member of staff. Please tick.

Signed:
Approval Signatory / Date:

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