Student Application Form - Royal National College for the Blind

Section 1 – Applicant Details

Known as

Pronoun

Home Telephone Number

Applicant's Mobile Number

Applicant's Email Address

Next of Kin's Home Phone Number (if different to applicant)

Next of Kin's Mobile Number (Required)

Next of Kin's Email Address (Required)

Next of Kin's Relationship to Applicant (Required)

Section 2 – Applicant's Health Information

What is the primary cause of your visual impairment? (Required)

Please list what medical conditions/disabilities or learning difficulties you have. (Required)

Please list what allergies or special dietary requirements you have. (Required)

Please state what other professionals you see. (Required)

Please state what other mobility aids you currently use. (Required)

Do you require us to consider any access arrangements? (Required)

Section 3 – Applicant's Education Information

Please provide details of your current career/employment goal. (Required)

Please provide details of any paid or voluntary work experience you have completed?

What are your hobbies and interests? (Required)

Section 4 – Stakeholder and Professional Contact

Section 5 – Additional information

Please specify print size and format, e.g. Arial 18pt bold. (Required)

Please specify what your working medium is. (Required)

Please provide details of any IT equipment and assistive technology or specialist software you use. (Required)

If there is any additional information you would like to provide us with?

Section 6 – Marketing Information

Please specify in further detail if possible about how you first heard about RNC.

Section 7 – Privacy Notice, Data Protection and Personal Information

By completing this form your details will be held on our student record system and will be used for the purpose of administration, guidance and monitoring to assist you with your education whilst at RNC. As part of our admissions process, we will send you information and communications relating to your application and admissions (by email, text, post or phone). RNC will occasionally make student information available to external agencies (e.g. examination boards, careers service, result publications, government agencies, prospective employers etc.). We may also share your information with your current school and any other nominated support worker or representative you may be working with to help you through our application process. The details you have provided may also be shared with internal / external support staff to ensure appropriate support is provided. The data you supply may also be used to check for, or obtain, a unique learner number (ULN). RNC is committed to equal opportunities, our Equality Policy can be found on our website.

Signed (potential learner) (Required)

Signed (parent/carer if learner is under 18)