For Office use 1

Student Reference
received

ApplicationForm
YES NO

Section 1 PLEASE PRINT CLEARLY IN BL OCK Please attach passport size

CAPIT AL S T HROUGHOUT USING BLACK INK photograph here

Details of the course(s) Proposed year

for which you wish to of entry
apply
20__ __

You should complete this

application form as soon as
Dates not available for interview possible and send it to
The Admissions Officer
Leeds College of Art
From To
Blenheim Walk
Leeds LS2 9AQ
t 0113 2 0 2 8 0 0 0

Section 2 Section 3

Surname Which country do you normally live in?

Other Names

Age on next Date of birth Where have you been living for the last three years?
31 August
Title Mr Mrs Miss Ms Other

Correspondence address: please note that this address will be used What is your Local Education Authority?
by the College for all correspondence. Please tell us of any changes.

What is your nationality?

Postcode Tel Section 4

Mobile phone No Please give the name and address of your

present school or college or any other educational
E-mail address establishment you have attended in the last
three years

Home address if different from above

Postcode Tel
2
Section 5 Additional Support
This section is designed to enable us to provide appropriate resources to assist you.
The College wishes to ensure that it complies with the requirements of the DDA (as
amended by the Special Educational Needs & Disability Act 2001). If you are a
disabled person, please ensure that we know what you need so that we can make all
reasonable adjustments to help you succeed.
Please tick any boxes that apply.
I do not have a disability I have dyslexia I am blind or partially sighted

0 1 2
I am deaf or hard of hearing I use a wheelchair or have mobility I need personal care or assistance
difficulties
3 4 5
I have mental health difficulties I have a disability that can not be seen, I have a disability, special need or
eg, diabetes, epilepsy or a heart condition. medical condition that is not listed above.
6 Please detail in your Personal Statement 7 Please detail in your Personal Statement 8

Section 6 Equal Opportunities

To enable us to improve the services we offer, please complete the following
information which will be used to develop and monitor equality and diversity in the
College. Please tick any of the following boxes that apply to you.
Asian or Asian or Asian or Asian or Black or Black or Black or
Asian British - Asian British - Asian British - Asian British - Black British - Black British - Black British -
Bangladeshi 11 Indian 12 Pakistani 13 any other Asian 14 African 15 Caribbean 16 any other Black 17

background background

Chinese Mixed - Mixed - Mixed - Mixed - Female Male

White and White and White and any other
18 Asian 19 Black African 20 Black 21 mixed 22

Caribbean background

White -British White - White - any Any other Not

Irish other White known/not
23 24 background 25 98 provided 99

Section 7 Criminal Convictions

Please give details of any relevant criminal convictions which are not spent,
(as defined by the Rehabilitation of Offenders Act 1974)

Section 8 Qualifications
Please use the columns below to list the predicted or actual grades for
examinations you have taken or are about to take

Subject or main area of study Level Examining Board Date taken/ Result/
eg GCSE, First Diploma eg EDEXCEL, AQA, to be taken result expected
Access or A Level OCR
 3
Section 9 Personal Statement

Please use this space for any other information to support your application.

• why you wish to apply for this course(s)

• skills and strengths you have to offer
• interests, voluntary activities
• employment and work experience
• continue on a separate sheet if necessary

I agree to Leeds College of Art processing personal data which includes

Checklist sensitive data, contained in this form and the attached Student
Have you completed Reference. I agree to the processing of such data for any purposes
connected with my studies or my health and safety whilst on the premises
all your personal details? or for any other legitimate reason. (please see Note 9)

Signature of applicant
all the details about the course for which you are applying?
Date
all the details about your present qualifications?

Have you included

If you are under the age of eighteen, this form must also be signed by
a passport-sized photograph?
your parent or guardian.
your Student Reference form?
Signature of parent/
guardian
Date
Is your Student Reference form to follow?
4
For College use Interview Notes

INTERVIEW PANEL

Name Course Date of interview

A C A D E M I C A C H I E V E M E N T S (if GCSE at Grade ‘C’ or above)

Present examination results No English YES NO

Maths YES NO

Predicted examination results No English YES NO

Maths YES NO

FURTHER STUDY POTENTIAL AT LEVEL APPLIED FOR

Portfolio Excellent Good Average Some Considerable Reference supportive
problems weaknesses

Quality Yes No

Quantity

Range

Communicating Attendance

Oral Good Average Poor

Written

COMMENTS

RESULT

1ST INTERVIEW UO CO Re-interview required Rejection

2ND INTERVIEW UO CO Rejection

Course accepted for:

Conditions of offer:
REJECTION When an applicant is rejected please tick the appropriate box/es with the reason/s for rejection

1 Insufficient or poor quality practical work 2 Lack of appropriate academic ability

3 Insufficient evidence of commitment 4 Wrong choice of course
5 Withdrew at interview 6 Did not arrive

7 Other (please specify)

5000/03.09
 L EED S CO LL EG E O F AR T
Notes to
assist you
in completing
the
College
Application
Form

Note 1 Further help if you are uncertain about which course to apply for

If you are finding it difficult to decide about which course to apply for or need further information, please contact
the Student Advice Team on 0113 202 8000. Alternatively, you could drop in at our office at Blenheim Walk or
email us at [email protected].

Note 2 Mature Students

Leeds College of Art welcomes applications from mature students. As we understand that it is often a major
decision to return to study, you can contact the Student Advice Team to discuss your qualifications and
experience or any other issues such as finance and childcare.

If you do not have any formal qualifications, please don’t be concerned about leaving the Q U A L I F I C A T I O N S
section (8) of the Application Form blank. However, please do fill in the P E R S O N A L S T A T E M E N T section (9) as
fully as you can.

If you require additional space for your qualifications please complete and enclose these on a separate sheet.

Note 3 Student Awards

The Student Advice Team provides information and advice on various student awards that you may be entitled
to, including:

• Education Maintenance Awards

• Adult Learners Grant

• Access Funds

If you require any further information concerning these awards or need general information on student finance
and funding please contact the Student Advice Team.

Note 4 References - These are needed for all Full-time and Part-time applications

(a) If you are still at school or a full-time student at a College of Further Education you should give the form to
your Head Teacher or Head of Department.

(b) If you are not in full-time education, please pass the form to the person you have nominated as your referee.

Note 5 Criminal Convictions

If you have a criminal conviction, which is relevant and not spent, you must disclose it. This will not automatically
exclude your application, but we may want to consider it further, or ask for more information before making a
decision.

Relevant convictions are those against the person, whether of a violent or sexual nature, and convictions for
offences involving unlawfully supplying controlled drugs or substances.
 L EED S CO LL EG E O F AR T Notes to
assist you
in completing
the
College
Application
Form

Note 6 Interviews

Once the Admissions section has received your application and reference, they will write to you to explain
the interview arrangements for your course (some courses interview before others , depending on the nature of
the course).

You should be prepared at interview to tell us about yourself and make clear your reasons for applying. If you
have a Record of Achievement or any other summary of experience, (eg a CV) please bring this along to the
interview.

Note 7 The Result of the Interview

You will hear from us within 10 working days of your interview. Our letter will contain one of the following offers;

1 An unconditional offer of a place. This is a firm offer with no conditions attached.

2 A conditional offer of a place. This usually means that you have to achieve satisfactory exam results before
you can be offered a firm place. The letter will explain the conditions in detail.

3 A reserve or waiting list place. In this case you will only be accepted on your course if a place becomes
available and your exam results are satisfactory.

4 An invitation to a further guidance interview. This means that after your first interview the course tutor
felt another course might be more suitable.

If you do not fully understand the offer made to you, please telephone the Admissions section using the main
College number 0113 202 8000.

Note 8 If you are unhappy with any aspect of your interview, please contact the head of School of Further Education, for
help and guidance.

Leeds College of Art is committed to ensuring equal opportunities.

Please remember

1 Applications for some courses may be delayed if we do not receive a reference (note 4).

2 Your application form and personal statement is often our first impression of you - please complete it fully
and with care.

3 If you require any further help, contact the Student Advice Team on 0113 202 8000.

Note 9 The College collects information about all our staff and students for various administrative, academic and health
and safety reasons. This data may be shared with other institutions. Because of the Data Protection Act 1998, we
need your consent before we can do this. Since we cannot operate the College effectively without processing
information about you, we need you to sign this consent to process clause. If you do not do so, we
will be unable to offer you a course place. If you require any further information about this, please contact the
student admissions office.

5000/03.09
LEE DS CO LLEGE O F AR T This form should be
completed by
Headteachers,
Year Tutors,
Careers Teachers,
Art Teachers,
Design Technology
Teachers or (past)
employers, or, if
none of these is
available, a person
not related to you
but who knows you
and/or your work
Student Reference
Please be advised that this reference may be shared with the applicant, and as such is not confidential

Name of applicant Date of birth (if known)

Course applied for

Reference completed by Name in capital letters Signed

Job title

School/College/Employer/
Other
Name and address

Section 1
Please give your assessment of the applicant's record

Excellent Good Average Has some Has

difficulties and considerable
problems weaknesses

Attendance/motivation

Further study potential

Section 2
Please give your assessment of likely attainment in examinations by circling number of subjects

GCSE (Grades A to C) 1 2 3 4 5 6 7 8 9 10

'A' Level (passes) 1 2 3 4 5 6 7 8 9 10

Other (please specify)

Section 3

Please give your comments on the suitability of the applicant for the course, and any other details you feel may be relevant

Section 4
Has the applicant any medical or physical problems (eg asthma, epilepsy, hearing difficulties) that we should be aware of for
health and safety reasons? (Please note – The Data Protection Act 1988 and subsequent human rights legislation requires
that the specific consent of applicants be obtained for this information to be included.

YES NO

If Yes, please give details

This form may be sent with the application form, or if you prefer it to be confidential, please return it separately to the following address:
The Admissions Officer, Leeds College of Art, Blenheim Walk, Leeds LS2 9AQ
Telephone 0113 202 8000 Fax 0113 202 8001
5000/03.09