A-Level study application

Please complete all fields below (do not include any spaces in phone numbers), we will process your application and contact you for payment.

Forename(s):

Surname:

Sex:

Date of Birth:

Age on Application:

Nationality:

Religious Denomination:

Name, Initials and Title of Parent:

Professional Status of Parent:

Home Address:

Postcode:

Home Telephone Number:

Parent's Office Telephone Number:

Parent's Mobile Number:

Student's Mobile Number:

Home Fax Number:

Home Email address:

Name, address and telephone number of your guardian in England:

Postcode:

Name, address of person or persons or Company responsible for payment of Account:

Telephone Number:

Facsimile:

Name and address of the School/College you last attended:

Postcode

Type of School/College

Examinations you have already attempted

Examination subjects for which tuition is required

Date to commence your studies with Cherwell:

Date to complete your studies with Cherwell:

Please state the number of terms registered with Cherwell:

Name, address and status of one person who can provide a general character reference for you:

Postcode:

Please list any academic interests you may have:

Do you require accommodation?

If yes, what
style of accommodation

Any other details (medical information etc):

The name and address of the person, or agency, who recommended Cherwell to you:

Postcode

The name(s) of other Cherwell students known to you, past or present:

Any Questions?

I declare that I have received, read and understand the College Prospectus and the Terms and Conditions of Acceptance and agree to be bound by all the terms and conditions contained therein.Yes