MONTESSORI CENTRE INTERNATIONAL
Marlborough House, 38 Marlborough Place, London, NW8 0PE
Tel: 020 7493 8300
COURSE APPLICATION FORM
Personal DetailsSurname/Family Name:Click here to enter text. First name: Click here to enter text.
PreviousName(if applicable): Click here to enter text. Title:(Mr/Msetc): Click here to enter text.
DateofBirth:(DD/MM/YY): Click here to enter text. Gender:Choose an item.
HomeAddress: Click here to enter text.
CorrespondenceAddress(if different) Click here to enter text.
TelephoneNo: Click here to enter text. Mobile:Click here to enter text.
Email: Click here to enter text Skype address: Click here to enter text.
Please indicate which course you are applying for:
Course / Full-time / Direct Entry / OnlineFoundation Degree Montessori Early Childhood Practice
(2 years full-time or direct entry to Level 5 for MCI Diploma Level 4 graduates or
Online study). / ☐ / ☐ /
Cert HE Montessori Early Childhood Practice (I year full-time) / ☐ /
Part-time / Online
Diploma Montessori Pedagogy – Birth to Seven (Early Years Educator) L3 / ☐ / ☐ /
Diploma Montessori Pedagogy – Birth to Seven (Early Years Educator) L4 / ☐ / ☐ /
Integrating Montessori Practice(IMP) / ☐ /
Intended start date (month and year): Click here to enter a date.
OFFICEUSEONLY – Donot completeInterview outcome: UnconditionalOffer: ☐ ConditionalOffer: ☐ Reject: ☐
Conditional offer now Unconditional: Signed: Date:_____
______
Educational Qualifications – Start with the most recent first. Copies of certificates or transcripts will need to be provided with NARIC statement of comparability (where relevant).
N.B. Please indicate that your qualifications include GCSE English and Maths at grade C or above (or equivalent) ☐
School/College/University / Award type (Degree,
Diploma,NVQ, Alevel,
GCSE,GNVQ etc.) / Subject(s) / Grade / Dateawarded
(Pleaseindicateifresultspending)
English Language Qualification – Please complete this section if English is NOT your first language. Please indicate which English Language Qualification you have, this should be IELTS 6.5. Please note that studying in English outside of the UK does not exempt you from submitting a qualification.
Qualification Name / Grade / Award Date
Employmentandworkexperience
Employer / Position andbriefoutlineofduties / Datesemployed
Next of Kin
Name: Click here to enter text.
Contact Number: Click here to enter text.
Relationship to student: Click here to enter text.
Residential Information
For students intending to study via attendance at MCI London College or a UK Centre. Please note MCI does not currently hold Tier 4 status and can only accept students resident within the EU/EEA or with a full and relevant visa for the duration of their course of study. You will need to bring your passport to interview and provide a colour photocopy of your passport photo page and visa.
CountryofPermanent Residence:Click here to enter text. CountryofBirth:Click here to enter text.
Nationality(asonpassport): Click here to enter text.
Haveyou entered theUKon a visa?Yes ☐ No ☐
Ifyes,enterexpirydateandtypeofvisa: Click here to enter text.
Haveyoubeengrantedindefiniteleavetoremain? Ifyesenterdate: Click here to enter a date.
Disabilities/Additional Support Needs/Health Details
None ☐ Physical impairment/mobility issue ☐
Social/communication impairment/Asperger’s ☐ Dyslexia ☐ Dyspraxia ☐
Any other learning difficulty ☐ Hearing impairment ☐
Visual impairment ☐ Mental health condition ☐
Long standing illness/condition ☐ Anorexia or Bulimia ☐
Have you ever been assessed by an educational psychologist? ☐ (If yes please provide a copy of the assessment)
Have you received treatment/medication over the past 12 months for a physical/psychologicalcondition? ☐
Please provide brief details and/or any additional support needs:
CriminalConvictions
Applyingfora course ofstudy thatwill involveworkwith childrenis exceptedunder theRehabilitation ofOffendersAct1974,whichmeans that all convictions,cautions,reprimands and finalwarnings on your criminal recordneedto bedisclosed includingspent convictions. Youwill berequiredto providean ‘EnhancedDisclosureDocument’ fromtheDisclosure and Barring Service asstipulatedby the ChildrenAct1989. Outside the UK local regulations will apply and must be confirmed by the placement setting prior to the student starting the placement.
Haveyouever been convicted bythecourtsor cautioned,reprimanded or given a finalwarningbythepolice? Yes ☐ No ☐
Areyouawareofanypoliceenquiriesundertaken followingallegationsmadeagainst you? Yes ☐ No ☐
Ifyes, please attachdetailsof youroffences, penaltiesanddates.Thiswillnot automatically exclude youfrom the applicationprocess. This informationshouldbe submitted inaseparate sealed envelope,clearlymarked confidentialwithyour name anddate ofbirthonit.Any informationdisclosedwill behandledand disposedof securely inlinewithDBSCode ofPracticeand the DataProtectionAct.
FeePayment–pleaseprovidedetailsofhowyou intend topay yourtuition fees.
Yourself/relative: Yes ☐ Localauthority(pleasespecify): Click here to enter text.
Employer(pleasespecify): Click here to enter text.Other(pleasespecify): Click here to enter text.
For any FdA and CertHE students: Will you be applying for a Student loan ☐
Checklist
Pleasemake sureyou havecompletedallsectionsofthisform.
To accompany this form you will need to provide forinterview:
Certificates/transcriptsto show evidence you meet the requirements of the course you are applying for (including English Language Testing).
Yourpassport. Ifyou area non EU/EEA national intending to study at MCI London College or UK Centre you will need a full and relevant visa for the duration of your studies and will need to provide a colour copy ofboth sides of your visa permit.
- 2 written reference statements (academic or professional)
- For those applicants whose first language is not English. An IELTS (Academic) test report showing an overall band score of 6.5 (please inform us as soon as possible of the intended date of your IELTS test)*
Followingtheinterview,on offer ofan unconditionalplace,you willneed toprovide:
*Health and Medical form (Diploma, Foundation Degree & Cert HE applicants)
*Completed Registration form and Registration fee of £100. (*Please note, the registration fee is non-refundable).
EthnicityMonitoring
MCIiscommittedtoprovidingequal opportunitiesfor all. Toassistuswithour monitoring pleasechooseone selectionfromA– Etoindicateyour ethnicgroup,tick theappropriateboxtoindicateyour culturalbackground.
A / White / White British / Irish / Any other White background
B / Black or Black British / Caribbean / African / Any other Black background
C / Asian or Asian British / Indian / Pakistani / Bangladeshi / Any other Asian background
D / Mixed / White and Black Caribbean / White and Black African / White and Asian / Other mixed background
E / Other / Chinese / Arab / Other ethnic background / Gypsy or Traveller
Declaration
Any statementsof thisform which prove tobeuntrueor deliberately misleadingwill render theapplicationinvalid. If any inaccuraciesarehighlightedat a later stageweretaintherighttoretract any offer madewithnorefundof fees.
Iconfirm that theinformation providedonthisform istrue, completeandaccurate.
Your personal information is important to us. By signing below, you are agreeing to letting us store your information. This allows us to stay in touch with you and keep you up-to-date with the latest news and events about college development and our charitable efforts.
Your data will be protected by our secure IT server. If at any point you would like more information about how your data is secured or to opt out, please call 020 7493 8300 or email .
We never share any data with third party organisations.
Signed: Date: Click here to enter a date.
MarketingMonitoring
Pleaseindicate howyou heard about MontessoriCentreInternational:
Internet search: ☐Personalrecommendation: ☐Employer: ☐CareersAdvisor: ☐
Pressarticle(specify): ☐Other(pleasespecify) ______
PersonalStatement:(Thiswill form thebasisof discussion duringthe interview)
Whydoyouwant towork withyoungchildrenandstudywith MCI to become a Montessori educator?
What particular skills andqualities doyoubringwithyou?
K.A/P.J – 13/10/2016
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