Clearing Enquiry Form

Please complete the form below and we will contact you as soon as possible. Don't forget to give us your phone number if you'd prefer us to phone you for a chat about your choice of course.

Title	* Please insert your Title
First Name	* Please insert your First Name
Family Name	* Please insert your Family Name
Address Line 1	* Please insert the first line of your address
Address Line 2
Town or City	* Please insert your Town or City
County, Region or State
Postcode (if UK) or Name of Country	* Please insert your Postcode (if UK) or Country (if overseas)
Contact Telephone Number 1
Contact Telephone Number 2 (optional)
Email Address	* Please insert your email address  * Please insert a valid email address
Date of Birth
Gender	Please select ... Female Male   * Please select your Gender
Course(s) or Subject(s) of Interest	* Please give details of the subjects or courses you wish to study
Mode of Study	Please select ... Full-time Part-time   * Please select your preferred Mode of Study
Which School or College are you currently attending?	Name of School/College
	Location of School/College
What qualifications do you have (including grades)? Please include details of ALL your qualifications including Level 2 qualifications (GCSEs or equivalent) and Level 3 qualifications (A-levels or equivalent)	* Please give full details of all the qualifications you hold
Have you applied through UCAS for entry this September?	Please select ... Yes No * Please state if you have applied through UCAS for entry this September	If Yes, please give your UCAS Personal ID
We would like to keep you informed of the activities of the University of Bolton (e.g. open days and newsletters). Please tick this box (left) if you would prefer not to receive this information. Your personal data will be stored on a database and will be used for the purposes of keeping you informed about the University of Bolton and its study opportunities. We may also ask you to help us with our marketing research (e.g. questionnaire about your experiences applying to us). We do not release your data to third parties, external to the University of Bolton. By submitting this form, you give permission for us to hold your data, and use it in this way.