APPLY FOR SIXTH FORM 1 2 3 4 5 6 7 8 9 10 11 12 13 - - - STUDENT DETAILS - - - Data protection: the college is legally required to pass on certain information to service providers on request. This information includes the name and address of the student and parent, and any further information relevant to the youth support service’s role. However, parents or the student themselves (if aged 16 or over), can ask that no information beyond name and address be passed on (the youth support service is the government’s support service for all young people aged 13 to 19 in England. It also provides support up to the age of 25 for young people who have learning difficulties or disabilities (or both). Do you give your consent for your information to be provided to youth support service? * Yes No Student Gender* Male Female Student Date Of Birth* Next - - - PARENT 1 DETAILS - - - First Parent Parental Responsibility* Yes No Prev Next - - - PARENT 2 DETAILS - - - Second Parent Parental Responsibility* Yes No Prev Next - - - EMERGENCY CONTACT 1 DETAILS - - - Prev Next - - - EMERGENCY CONTACT 2 DETAILS - - - Prev Next - - - MEDICAL INFORMATION - - - Do You Use An Epipen* Yes No Do You Have a Medical Condition or Disability* Yes (Please state below) No If you have a medical condition or disability we should be aware of, or if you have to take medicine / tablets on a regular basis, have epilepsy, diabetes, asthma, hay fever / allergies or any other medical condition or disability, please state. Prev Next - - - NATIONALITY - - - Ethnic Origin* Asian Background Bangladeshi Black Background Black British Black Caribbean Black Ghanaian Black Nigerian Black Somali Chinese Gypsy / Roma Indian Latin / South / Central American Other Black African Other Ethnic Group Other Mixed Background Pakistani Traveller of Irish Heritage White and Asian White And Black African White And Black Caribbean White and Chinese White British White European White Irish White other Yemeni I refuse to say Other (please state) Country Of Birth* United Kingdom Other (please state) Prev Next - - - LANGUAGE - - - Is English Spoken At Home?* Yes No The Main Language Spoken At Home* Arabic Bengali Chinese Cornish Cymraeg English Greek Hindi Italian Manx Portuguese Punjabi Spanish Turkish Urdu Other (please state) Prev Next - - - RELIGION - - - Please State Your Religion* Roman Catholic Church Of England No Religion Other (please state) Prev Next - - - COLLEGE INFORMATION - - - Meal Arrangements* Free School Meal Paid School Meal Packed Lunch Biometrics With Finger Recognition* Yes No How Will You Travel To College* Bike Bus Car Taxi Train Walk Photo Permission For College Publicity* Yes No Does Your Child Require Exam Assistance* No * Extra time * Use of laptop * Scriber * Scriber * Have You Read The College Rules* Yes No Have You Read The Uniform Regulations* Yes No Prev Next - - - OTHER INFORMATION - - - Are Parents In The Armed Services* Yes No Are Parents Former Member Of Armed Services* Yes No Are You A Registered Carer* Yes No Do You Want Registered Carer Information* Yes No Are You In Public Care* Yes No Prev Next - - - A LEVEL CHOICES - - - A Level - Choose a maximum of 4 Options Art Biology Business Chemistry Dance English Literature Fashion Geography History Maths MFL (French) MFL (Spanish) PE Physics David Campbell Soccer LLS Prev Next - - - VOCATIONAL CHOICES - - - Vocational - Choose a maximum of 4 Options Applied Law Business Health ICT Media Performing Arts Psychology Science (Grade 5 in science) Sport Travel 8 + 3 = Submit