Title * Required

First Names * Required

Surname * Required

Also known as

Date of Birth * Required

Gender * Required

Home address including county and postcode * Required

Home telephone number * Required

Mobile number * Required

Email * Required

Country of normal residence if not UK * Required

If yes, please enter your passport number and expiry date. * Required

If yes, please enter your BRP number and expiry date. * Required

What type of permit have you been allocated? * Required

If yes, please give details: * Required

Have you attended RNC before? If yes, please give details, e.g. year and course

Please indicate whether you wish to be considered for a residential or day placement * Required

Next of Kin First names * Required

Next of Kin Surname * Required

Next of Kin Postal address * Required

Next of Kin Telephone number * Required

Next of Kin Mobile number * Required

Next of Kin Email * Required

Next of Kin preferred medium for contact/correspondence * Required

Next of Kin relationship to student * Required

Other please specify

Are you registered blind or partially sighted? If yes, please provide date of registration * Required

What is the cause of your visual impairment? * Required

Do you have a hearing loss or impairment? If yes, is it in left/right/both ears? * Required

Do you wear a hearing aid? * Required

Do you have any other impairment or medical conditions that you feel we should be made aware of? * Required

Do you consider yourself to have a learning difficulty? If yes, please provide details. * Required

Other please specify

Do you have a career/employment goal? If so, please specify * Required

Which programme would help you achieve your career/employment goal? [Please refer to current RNC prospectus for more information] * Required

Please state which schools/colleges you have attended since the age of 11, starting with the most recent. * Required

Qualifications achieved * Required

If you are still at school or left within the last year, please provide name and address of a person who would be able to supply a report about you [e.g. Headteacher].

Have you attended any rehabilitation or work preparation training? If yes, please give details

If you have recently left employment or undertaken work placement, please provide name and address of a person who has worked closely with you and could provide a reference.

Are you currently employed? If yes, please provide employer's name, address and a brief outline of your duties.

Please provide details of any work experience carried out to date - include any full-time, part-time, paid or voluntary work which may be applicable to your application. Provide employer’s name, address and brief outline of tasks performed and dates from - to.

Name * Required

Email * Required

Postal Address * Required

Telephone * Required

Mobile * Required

Name * Required

Email * Required

Postal Address * Required

Telephone * Required

Mob number * Required

Name * Required

Email * Required

Postal address * Required

Tel number * Required

Mob number * Required

Are you a guide dog user? If yes, what is your guide dog’s name? * Required

Please indicate whether you are awaiting guide dog training.

Are you a long cane user? * Required

Are you a symbol cane user? * Required

Do you use any other mobility aid? If yes, please give details. * Required

Have you received any formal mobility training? If yes, please give details. * Required

Are you a wheelchair user? * Required

Please give further details below including which technology you use. For example, a Brailliant * Required

If yes, do you use any specialist hardware [e.g. alternative keyboard, joystick] or software [e.g. JAWS, SuperNova, Zoomtext].

What are your hobbies and interests? * Required

Do you have any special dietary requirements? * Required

Do you require us to consider any access arrangements? * Required

Further details, if applicable

Name: * Required

Date * Required

Consent [for completion by parent/guardian or carer if the applicant is aged under 18] – this application for my daughter/son/ward has my full support. Your Name: * Required

Date * Required

Relationship to applicant: * Required

Student Application Form