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FLEETWOOD NAUTICAL CAMPUS

bLearning
SENIOR MARITIME & BLENDED LEARNING
FLEETWOOD NAUTICAL CAMPUS
Broadwater, Fleetwood, FY7 8JZ
COURSE APPLICATION / BOOKING FORM Staff Use Only
Learner ID:
Tel (01253) 504800 Fax (01253) 773014 OOW & CM
Email: maritimeshortcourses@blackpool.ac.uk Please complete all sections in full in BLOCK CAPITALS

SECTION 1 – PERSONAL DETAILS

1. LEARNER DETAILS - Please provide your full name as found on your birth/marriage certificate or passport:
Surname/Family Name: Forename/First Name:

Title: Mr/Mrs/Miss/Dr/Other Date of Birth:

Gender: Ethnic Origin:


Personal Email Address: Mobile Number:
(Compulsory for communication)
Home telephone No:

Nationality: Country of permanent residence:

Country of Birth:

Next of Kin Name: To be used in case of an emergency Next of Kin Tel:

Discharge Book No: Passport No: National Insurance No:

Do you have a learning difficulty/disability? YES/NO (please delete)

Do you have any unspent criminal convictions? YES/NO (please delete)

2. ADDRESS – Please provide your home address:

Address:

Town:

County:

Country:

Postcode:

SECTION 2 - HOME STATUS

1. To be completed by EU and NON-EU learners:

Have you lived in the UK or EU for 3 continuous years prior to starting this course? ( circle as appropriate) YES NO

In which country is your Home or permanent address?

If living in UK, do you need a Visa to reside here? Yes No If Yes, please state Visa type:

Are you an international learner that requires a visa to enter the UK: YES NO

Are you currently in possession of a valid UK Visa Yes Please give details below No

Visa Type: Expiry date:

Maritime Booking Form 17.18


SECTION 3 – TO BE COMPLETED BY ALL INTERNATIONAL LEARNERS
Compulsory questions for ALL learners applying for FD, Chief Mate, Officer of the Watch and Masters Orals courses

What is your current occupation?

Why have you chosen to study in the UK?

Have you previously studied in the UK? YES/NO If yes, please provide full details and send copies of previous Tier 4/Study visas. Failure
to provide this information may result in visa refusal as strict conditions apply, this will be assessed for you by the College BEFORE you
apply.

Why have you chosen to apply to Blackpool & The Fylde College?

Have you ever been refused a visa, extension to an in country visa extension or entry to the UK? YES/NO if yes, please provide details of
when and under what circumstances.

How do you plan to fund your course fees and living costs in the UK?

Please provide the name of the bank/financial institution which you will be using to evidence your finances available to support your visa
application.

What do you intend to do once you have completed the course?

SECTION 4 – COURSE DETAILS & FEES - TO BE COMPLETED BY ALL LEARNERS:


It is your responsibility to ensure that you/your delegate have the correct entry requirements for the course.
EU students only - must provide a letter of sponsorship from a College approved employer if invoicing facilities are required.

Course Title: Course Date:


Are you paying your own fees? ( circle as appropriate) YES NO (Please provide details below)

Are you applying for an educational loan and will require a letter to support this YES NO

1. COMPANY/SPONSOR DETAILS – (EU Students only) 2. INVOICE DETAILS – (EU Students only)
Are You An Existing Company Customer? Yes / No
Company Name:
If no please contact the College

Company Contact: Invoice Address:

Address:

Town: County:

County: Postcode:

Postcode: Purchase Order:


Contact Email
Email Address:
Address:
Company I have read and accept the College terms & conditions
Telephone:
Tick
Company Stamp

1. ACCEPTABLE METHODS OF PAYMENT


 Cheque/Bankers draft payable to Blackpool and The Fylde College
 By your own Credit/Debit Card over the telephone on +44 (0)1253 504800
 Facilities are available to pay from your own personal bank account via a Bank transfer – full details available upon request
 We do not accept Travellers Cheques or Cash
 Invoicing facilities are not available for international students unless with prior arrangement with an existing Company customer.
Please be aware that once you are booked onto the course no refunds are available
Maritime Booking Form 17.18
SECTION 5 - RECORD OF SEA SERVICE DECLARATION FOR COURSE ENTRY
TO BE COMPLETED BY ALL LEARNERS
Name: Student Number:

Course:

Sea-time Requirements
OOW – 36 Months (1080 days) to include 6 months Bridge Watch Keeping experience
CHIEF MATES – 12 Months (360 days) following OOW award
MASTERS – 36 Months (1080 days) while holding OOW Unlimited COC or 24 months (720 days) if at least 12 months (360 days) of such
sea service has been served as Chief Mate while holding a Chief Mate Unlimited.
POST FOUNDATION DEGREE TO CHIEF MATE ORALS PREPARATION (PHASE 7)- Hold a valid OOW Unlimited II/I CoC, Have completed
12 months’ (360 Days) watch-keeping service while holding an OOW Unlimited II/I CoC

( Please refer to MSN1856 & MCA website for latest guidance)


What capacity are you currently serving at sea? :

Ship Date of Joining Ship Date of Leaving Ship Sea Service

Total Amount of Sea Service =

***** Please note, for Sea Service calculations only, 30 days Sea Service equates to 1 month *****
Should there be a short fall in your sea service due to booking your course in advance, please enter below the time you expect to spend at sea from
the date of booking to the start date of the course. Upon completion of the required sea service, it is YOUR responsibility to update the college with
a copy of your discharge book and sea service declaration form.
** It is important to note that if you fall short of the required sea service you will not be eligible to take the Certificate of Competency you would be
studying for the College will not issue you with a visa letter/CAS for visa purposes.

Ship Date of Joining Ship Date of Leaving Ship Sea Service

Total Amount of Sea Service =


Combined Total Sea Service =
Signed: Date:
Please note that the responsibility for determining your sea-time is a statutory matter and rests with the MCA. Matters concerning your sea-time
MUST be referred to the MCA in Southampton. You can contact MCA on 02380 329100
Please retain a copy of your Sea Service Declaration Form as you will be required to submit it when applying

Maritime Booking Form 17.18


for your visa.

SECTION 6
Please list below any relevant qualifications (including level) you have achieved together with any short courses you have attended,
and forward copies of all with your application: (Masters Orals CoC only required)
Certificate Held Level Certificate No. Date of Issue

HNC Certificate (Chief Mate students only)

Certificate of Competency

NVQ Marine Vessel Operations

HND in Nautical Science

Advanced Fire Fighting

Efficient Deck Hand

Elementary First Aid

Fire Prevention and Fire Fighting

GMDSS

Medical Care on Board Ship

Medical First Aid

NaEST (O)

ECDIS

NaEST (M)

Personal Safety and Social Responsibilities

Personal Survival Techniques

Proficiency in Survival Craft and Rescue Boats

Tanker Safety (Petroleum / Chemical / Gas)

SECTION 7 – AGREEMENTS

1. Compulsory for ALL INTERNATIONAL learners applying for Chief Mate, Officer of the Watch and Masters Orals courses

I can confirm that I have/will have sufficient funds to meet the Tier 4 Maintenance required when applying for entry clearance.

YES NO

I understand that the balance of all fees must be paid in full prior to the College issuing a CAS
YES NO

I understand that I must produce my passport, discharge book & CoC at enrolment
YES NO

Maritime Booking Form 17.18


I can confirm that I have checked with my local visa office that I satisfy their requirements for visa purposes.
YES NO

1. Documentation check list before forwarding to College (Please tick)


Completed booking form Copy of your NaRAST O Certificate (issued since January
2005) or valid ECDIS certificate required for all Chief Mate
Bookings
£1,000 Deposit payment (Full payment for Masters Copy IELTS for UKVI Certificate evidencing
Orals) Required levels of English. IELTS Certificates
are only accepted. (Not required for Masters Orals)
Copy of Passport- including copies of any previous
Sponsorship letter for invoicing purposes
Student Visas
(EU students only)
Completed Sea Service Declaration Form
Copies of all your certificates listed above (section 6)
Copy of full discharge book
Copy of your Notice of Eligibility (NOE) (if present)
Copy of your Certificate of Competency
(if applicable) Copy of HNC in Nautical Science Certificate (Chief Mate
Bookings only)

PLEASE NOTE YOUR BOOKING WILL NOT BE PROCESSED IF THE FORM IS INCOMPLETE OR ANY OF THE ABOVE SUPPORTING
DOCUMENTATION IS NOT PROVIDED

TERMS AND CONDITIONS


 All students are to pay £1,000 deposit for Chief Mate, Foundation Degree to Chief Mate Orals preparation (Phase 7) and Officer
of the Watch courses. Full payment at the time of booking is required for Masters Orals.

 Deposits/payments may be carried forward for a maximum period of 2 years which commences at the start date of your initial
course booked.
 All payments are strictly non-refundable but transferable to a later date.
 You have the right to cancel or withdraw your booking within 14 days of it being submitted. Please contact the Administration
Team on 01253 504800 or email maritime@blackpool.ac.uk including your full name, you date of birth and the course you have
booked for.

 Requests to defer to a later date must be received before a CAS is issued and the start date of the course.
 Students who request to transfer to a later course date and already have an unused CAS will incur a £55 administration fee;
this must be paid prior to you receiving another CAS.
 It is essential that you keep the College updated on a regular basis with regards to your visa application. Once the outcome is
received you are required to send a copy of the visa or refusal documentation to us.

 Transfer requests received following a visa refusal will be assessed on an individual basis.
 Bookings will not be accepted after the deadline for payment – 6 working weeks for September and May courses and 8 working
weeks for courses that commence in January.

 Students who have been granted a visa must enrol within 2 weeks of the start date of the course. Students who fail to enrol
within the 2 week deadline will forfeit the entire payment made to the College and be reported to the UKVI.

 IMPORTANT NOTE – Visas refused on grounds of false representation or documentation will result in students forfeiting their
entire payment to the College and no further sponsorship will be provided for future courses.

SEPTEMBER AND MAY COURSES – OVERSEAS LEARNERS It is recommended you have the required documentation
prepared
For September and May intake, 10 working weeks before the start date of the course students will receive an email to
request;

 Balance of FULL payment, including short courses


 Copy financial statements you intend to use when applying for your visa to evidence your funds for living costs. (Please bear in
mind that you must evidence that the required funds have been held CONSECUTIVELY for 28 day period (finishing on the date
of the closing balance) ending no more than 31 days before your application date)
 IELTS for UKVI Secure English Language Test which must demonstrate the acceptable score for each element
 Full copy Passport
 Full copy Seaman’s Discharge Book
 Full copy CoC (Chief Mates Only)
 Completed Sea Service Declaration Form

Maritime Booking Form 17.18


 Copy Tuberculosis medical card – within 6 months validity
 All the above, including the balance of FULL payment must be received no later than 6 working weeks before the start date of
the course.
 Strict Deadline - Balance of payments not received by the end of the 6 working weeks will result in you being deferred to a
later course date.
 Your CAS reference will be generated and issued to you once full payment and all the required documentation listed above has
been received, this will however be no earlier than 6 weeks before the start of the course.

JANUARY COURSES – OVERSEAS LEARNERS it is recommended you have the required documentation prepared
For January intake,12 working weeks before the start date of the course, students will receive an email to request;

 Balance of FULL payment, including short courses


 Copy financial statements you intend to use when applying for your visa to evidence your funds for living costs. ( please bear
in mind that you must evidence that the required funds have been held CONSECUTIVELY for 28 day period (finishing on the
date of the closing balance) ending no more than 31 days before your application date)
 IELTS English Language Test which must demonstrate the acceptable score for each element
 Full copy Passport
 Full copy Seaman’s Discharge Book
 Full copy CoC (Chief Mates Only)
 Completed Sea Service Declaration Form
 Copy Tuberculosis medical card – within 6 months validity

 All the above, including the balance of FULL payment must be received no later than 8 working weeks before the start date of
the course; this is required to allow for Christmas holidays.
Strict Deadline - Balance of payments not received by the end of the 8 working weeks will result in the student being
deferred to a later date.
 Your CAS reference will be generated and issued to you once full payment and all required documentation listed above has
been received, this will however be no earlier than 8 weeks before the start.

EU LEARNERS
Payment in full for the balance of all course fees including any short courses required must be paid at enrolment/arrival at College.
Payment can be made using one of the following methods:

 Cheque, bankers draft, BACS payment payable to Blackpool and The Fylde College
 Credit or debit card

Student Loan Company (EU STUDENTS ONLY)

If you are applying to the Student Loan Company for tuition fee loan/grant we advise you do this before the start date of your
course. Please note tuition fee loans/grants are paid direct to the College and may be used for statutory HE fees only, i.e. cannot be
used to fund any short courses. Please refer to the SLC website where full information is available on fee loans/grants and
maintenance awards www.slc.co.uk

Company Sponsored Students (EU) ONLY


 All Companies who require an invoice facility must already hold a College account.
 Invoice facilities are not available for international students unless for specific courses and by strict prior arrangement.
 Payment terms are strictly 45 days
 New Companies requiring an account/invoice facility must pay for their first student at booking stage, after which an account
may be requested / arranged, please note credit checks will be carried out.
 All Invoice addresses and contacts must be within the UK/EU
 Companies remain responsible for payment of the invoice in the event of the student leaving the Company

Education (HE) Learners - Important Information


Any learner who leaves within the first two weeks of their course will not be subject to any fees and will be entitled to a refund of any fees
that have already been paid.
Any learner who withdraws from their course in the 1st term will be liable for 25% of the fee as per SLC loans.
Any learner who leaves in the 2nd term will be liable for 50% of the fee as per SLC loans.
Any learner leaving in the 3rd term of their course will be liable for the full fee as per SLC loans. Only in exceptional circumstances will
we consider reviewing individuals’ situations, for example in cases such as a serious illness (etc.)

BLENDED LEARNING STUDENTS ONLY


 All students are to pay for Set One modules, SQA Registration and on-line registration at enrolment.

 All International students wishing to enter the UK must meet the United Kingdom Visas and Immigration (UKVI) criteria. We
strongly recommend you check that you meet the criteria before applying to enrol onto the course which requires a minimum of
4 visits to the UK.

 It is extremely important to note that the College will not sponsor students for visa purposes. Organisation of obtaining the
correct visa remains the sole responsibility for the student and that no fees will be refund for students who enrol onto the course
and subsequently cannot enter the UK for any reason.
Maritime Booking Form 17.18
SPONSORED CADETS
Students who withdraw from their Training Programme early and do not complete may be required to reimburse their Company any
fees incurred. It is the student’s responsibility to ensure that the details of which are obtained from their sponsoring Company and that
they are aware of the full contents of their Training Agreements in advance of enrolment at College.

ALL STUDENTS
Where permitted, HNC/HND exam resits will be charged for.

MASTERS ORALS & FOUNDATION DEGREE TO CHIEF MATE ORALS PREPARATION (PHASE 7).
 For all Masters Orals & Foundation Degree to Chief Mate Orals Preparation (phase 7) courses, students who require a short
term study visa, will receive a letter to support a Short Term Study visa application approximately 8/10 weeks before the start
date of the course.

 Bookings will only be accepted no later than 5 working weeks before the start date of the course; in these circumstances
students must arrange their own courier to collect their visa letter to support a student Visitor Visa application.

Short-Term Study Visas are only valid for a 6 month period from the date of issue. It is highly recommended therefore that
you apply for your visa close to the start date of the course whilst still allowing sufficient time for you to arrange travel

Applicant’s Signature: Date:

Date:
Company Representative’s Signature (if applicable):

Please return your completed booking form to maritimeshortcourses@blackpool.ac.uk.


We aim to process all bookings within 5 working days. Unfortunately the College cannot accept responsibility when receipt of the booking form is delayed by a
Company. Please refer to timeline above in relation to issuing your CAS and supporting documentation.
Should you require further information please contact us by telephone on 01253 504800 or email maritimeshortcourses@blackpool.ac.uk

Maritime Booking Form 17.18