INTERNATIONAL STUDENT
PRE-COURSE APPLICATION
FORM
Please complete this form, then scan and email to [email protected]
Pre-course needs a minimum of 10 students in order to run. If your chosen pre-course has fewer than
10 applicants it will be cancelled. You will be notified within a week of the last date to apply confirming
if your chosen course will run or not. If your chosen course does not run, we will normally offer you a
place on another pre-course.
PERSONAL DETAILS
Title:
First name/s:
Last name:
Gender:
Date of birth:
DD | MM
| YYYY
Permanent home address:
Postcode:
Term-time address (if different to above):
Postcode:
Mobile number:
Telephone number:
Email address:
PERMANENT RESIDENCE
England
Scotland / Wales
N. Ireland
Other (please state):
Parent / carers name (if under 18):
Health (please include details if you wish to notify us):
Emergency contact name and number:
COURSE DETAILS
BA / MA course name:
Isle of Man
Channel Islands
Preferred pre-course week:
21st – 23rd August 2017
25th – 27th September 2017
PAYMENT OF FEES
I enclose a cheque (payable to The Royal Central School of Speech and Drama) / authorise a card payment (as below) for the sum
of £485. Fees cannot be reimbursed once you have embarked on a course.
Authority to debit card
Please debit my Switch / Mastercard / Visa with the sum of £485.
Name of cardholder:
Card number:
Security code (last 3 digits on back of card):
Expiry date:
MM
| YY
Issue number (Switch only) or valid from date:
Card billing address (if different from above):
Postcode:
I / we the undersigned agree to abide by the joining conditions and understand that they will take effect on receipt of application
by The Royal Central School of Speech and Drama.
Signed:
DECLARATION AND
SENSITIVE DATA
Date:
CONSENT
TO
DD | MM
| YYYY
PROCESS
I confirm that the information given on this form is true, complete and accurate and no information requested or other material information has been
omitted. I understand that if my application is found to contain any false entries, misleading statements or material omission, The Royal Central School of
Speech and Drama reserves the right to cancel any application and that consequently any offer made will be withdrawn or attendance suspended. I
understand that the information supplied on this form will be retained by The Royal Central School of Speech and Drama and will be used for the purpose
of processing my application. In the event that my application is successful, I understand that the information will form part of my student record.
I give my consent to The Royal Central School of Speech and Drama for the recording and processing of information about me in the following
categories:
a) Race and ethnic origin
b) Age and gender
c) Disability, special needs or medical condition
d) Criminal convictions.
The information will be used within The Royal Central School of Speech and Drama records for the following purposes:
• Managing the absence control policy
• Checking suitability and fitness to study at The Royal Central School of Speech and Drama
• Checking suitability and fitness for course places
• Managing and maintaining a safe working environment
• Managing duties and obligations under the Sex Discrimination Act 1975
• Managing duties and obligations under the Disability Discrimination Act 1995 and the Special Educational Needs and Disabilities Act 2001
• Managing duties and obligations under the Race Relations Act 1976 (amended 2000)
• Managing duties and obligations under the Rehabilitation of Offenders Act 1974 and the Protection of Children Act 1999.
I understand that this information will be used only for the purposes set out in the statement above, and my consent is conditional upon the
Royal Central School of Speech and Drama complying with its obligations and duties under the Data Protection Act 1998.
Signed:
Date:
The Royal Central School of Speech and Drama is registered as a Company Limited by Guarantee, with exempt charitable status, in England and Wales under Company No. 203645.
Registered office: Eton Avenue, London NW3 3HY, UK. VAT No. GB 135 6002 46.
For copies in large print please telephone +44 (0)20 7722 8183.