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NAME
Prefix First Last
Date of Birth
MM slash DD slash YYYY
Address
Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country
TELEPHONE (HOME)
TELEPHONE (MOBILE)
TELEPHONE (WORK)
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SECTION 2: EMERGENCY CONTACT DETAILS
Please provide details of next of kin OR someone who can be contacted in case of an emergency
Name
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RELATIONSHIP TO YOU
TELEPHONE (HOME)
TELEPHONE (WORK)
TELEPHONE (MOBILE)
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SECTION 3: ENROLMENT DETAILS
DEGREE / COURSE TITLE
YEAR OF STUDY
STUDY STATUS
START DATE
MM slash DD slash YYYY
END DATE
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SECTION 4: FINANCIAL AGREEMENT
STUDENT SUPPORT NUMBER
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HOW WILL YOU BE FUNDING YOUR STUDIES
- Self-Funded
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SUPPORTING DOCUMENTS
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DECLARATION
- I have noted the costs mentioned in the above section and will be fully responsible for paying my tuition fees as per this agreement.
SECTION 5: STUDENT EQUALITY
DISABILITY / SPECIAL NEEDS
CODE TYPE OF DISABILITY
- 0 No known disability
- 8 Two or more impairments and/or disabling medical conditions
- 51 A specific learning difficulty such as dyslexia, dyspraxia or AD(H)D
- 53 A social/communication impairment such as Asperger's syndrome/other autistic spectrum disorder
- 54 A long standing illness or health condition such as cancer, HIV, diabetes, chronic heart disease, or epilepsy
- 55 A mental health condition, such as depression, schizophrenia or anxiety disorder
- 56 A physical impairment or mobility issues, such as difficulty using arms or using a wheelchair or crutches
- 57 Deaf or a serious hearing impairment
- 58 Blind or a serious visual impairment uncorrected by glasses
ETHNICITY
- 10 White
- 13 White - Scottish
- 19 Other White background
- 15 Gypsy or Traveller
- 21 Black or Black British - Caribbean
- 22 Black or Black British - African
- 29 Other Black background
- 31 Asian or Asian British - Indian
- 32 Asian or Asian British - Pakistani
- 33 Asian or Asian British - Bangladeshi
- 34 Chinese
- 39 Other Asian background
- 41 Mixed - White and Black Caribbean
- 42 Mixed - White and Black African
- 43 Mixed - White and Asian
- 49 Other mixed background
- 50 Arab
- 80 Other ethnic background
- 90 Not known
- 98 Information refused
CODE ETHNIC
COUNTRY OF BIRTH
NATIONALITY
(as on passport)
RELIGION OR BELIEF
- 1 No religion
- 2 Buddhist
- 3 Christian
- 4 Christian - Church of Scotland
- 5 Christian - Roman Catholic
- 9 Christian - Other denomination
- 10 Hindu
- 11 Jewish
- 12 Muslim
- 13 Sikh
- 14 Spiritual
- 80 Any other religion or belief
- 98 Information refused
CODE RELIGION
GENDER IDENTITY
- 1 Yes
- 2 No
- 98 Information Refused
Is your gender identity the same as the gender you were originally assigned at birth?
SEX IDENTIFIER
- 1 Male
- 2 Female
- 3 Other
Please state your sex
MARITAL STATUS
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Please state your marital status
SEXUAL ORIENTATION
- 1 Bisexual
- 2 Gay man
- 3 Gay woman/lesbian
- 4 Heterosexual
- 5 Other
- 98 Information refused
What is your sexual orientation?
SECTION 6: DATA PROTECTION ACT 2018 & GENERAL DATA PROTECTION REGULATION 2016
Data Protection
- Under the terms of the Data Protection Legislation (Data Protection Act 2018 and the General Data Protection Regulation 2016), I am giving my consent to The Islamic College to record and store my personal details, such as my e-mail address, home address, contact number/s, company address, and phone number/s. This data may be used for various purposes, such as sending newsletters, promoting courses, and providing updates on data protection policy and projects. Please tick this box to confirm your consent.
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