Ordinand Application Form

1
Personal Information
2
Programme Information
3
Training Information
4
How did you hear about us?
5
Complete

Personal Information

St Mellitus College will be required to collect, store, use and otherwise process information about you for purposes connected with the application process and for reasons deemed necessary in order to take steps prior to you entering into a contractual agreement with the College. See GDPR Article 6(1)(b). For more information about what we will do with your data, please visit www.stmellitus.ac.uk/privacy-policy. Please ensure you have the consent of all third parties (such as referees) before you disclose any of their personal information to St Mellitus College

Prefix

If other, please specify

First Name

Known As (if different)

Last Name

Date of Birth (DD/MM/YYYY)

Gender

Male

Female

Prefer not to say

Nationality?

Ethnicity

Marital Status?

Spouse's name?

Number of children?

Ages of children?

Dietary Requirements (if any)

Do you have a criminal record?

Yes

Have you been convicted of any criminal offence during the past four years? If yes, please state the nature and date(s) of the offence(s).

Criminal Record Offences and Dates

Your Contact Details

Address Line 1

Address Line 2

City/Town

Post Code

Phone Number

Email Address

Emergency Contact Name?

Emergency Contact Number

Emergency Contact relationship to you

Home church name and address

Disabilities / Specific Learning Difficulties

Do you have a disability??

If yes, what?

If other, please specify

Please include details of any disability

Do you have a Specific Learning Difficulty (SpLD)? ?

If yes, what?

If other, please specify

If other, please include details

If you answered yes to the above, have you had a professional diagnosis within the last 5 years?