Sixth Form Application

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?

Data protection * Data protection * Yes No

STUDENTS

Your forename *

Your middle name

Your legal surname *

Your preferred surname *

Your home address *

Your post code *

Your mobile number *

Your gender * Your gender * Male Female

Your date of birth (DD/MM/YYYY) *

PARENT 1 (DETAILS)

Title: 'Mr', 'Mrs', 'Ms', 'Other' *

Forename *

Surname *

Home address *

Post code *

Home telephone number *

Mobile number *

Work telephone number

Email *

Parental responsibility *

Relationship to student *

PARENT 2 (DETAILS)

Title: 'Mr', 'Mrs', 'Ms', 'Other' *

Forename *

Surname *

Home address *

Post code *

Home telephone number *

Mobile number *

Work telephone number

Email *

Parental responsibility *

Relationship to student *

EMERGENCY DETAILS

RELATIVE OR FRIEND 1 (DETAILS)

State ('Nan', 'Uncle', 'Friend' etc) *

Forename *

Surname *

Work telephone number

Home telephone number *

Mobile number *

RELATIVE OR FRIEND 2 (DETAILS)

State ('Nan', 'Uncle', 'Friend' etc) *

Forename *

Surname *

Work telephone number

Home telephone number *

Mobile number *

MEDICAL INFORMATION

Do you use an epipen? * Do you use an epipen? * Yes No

Let us know 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 we should be aware of. *

LANGUAGE, NATIONALITY, RELIGION

Ethnic origin: please state * Ethnic origin: please state * 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)

If 'Other', please state

Is English spoken at home? * Is English spoken at home? * Yes No

The main language spoken at home * The main language spoken at home * Arabic Bengali Chinese Cornish Cymraeg English Greek Hindi Italian Manx Portuguese Punjabi Spanish Turkish Urdu Other (please state)

If 'Other', please state

Country where you were born * Country where you were born * United Kingdom Other (please state)

If 'other', please state

Your religion: please state * Your religion: please state * Roman Catholic Church Of England No Religion Other (please state)

If 'other', please state

IN COLLEGE

Meal arrangements * Meal arrangements * Free School Meal Paid School Meal Packed Lunch

Biometrics with finger recognition? * Biometrics with finger recognition? * Yes No

How will you travel to college? * How will you travel to college? * Bike Bus Car Taxi Train Walk

Photo permission for college publicity? * Photo permission for college publicity? * Yes No

Are you entitled to exam concession? * Are you entitled to exam concession? * Yes No

Do you have special educational needs? * Do you have special educational needs? * Yes No

Have you read the college rules * Have you read the college rules * Yes No

Have you read the uniform regulations * Have you read the uniform regulations * Yes No

OTHER INFORMATION

Are parents in the armed services? * Are parents in the armed services? * Yes No

Are parents former armed services? * Are parents former armed services? * Yes No

Are you a registered carer? * Are you a registered carer? * Yes No

Do you want registered carer info? * Do you want registered carer info? * Yes No

Current school or last school attended *

Post code of your current/last school *

Are you in public care? (looked after)? * Are you in public care? (looked after)? * Yes No

CHOOSE A MAXIMUM 4 SUBJECTS

A Level Subject Options * A Level Subject Options * Art Biology Business Chemistry Dance English Literature Fashion Geography History Maths MFL (French/Spanish) PE Philosophy & Ethics Physics

CHOOSE A MAXIMUM 4 SUBJECTS

Vocational Subject Options * Vocational Subject Options * Business Health ICT Media Performing Arts Psychology Science (Grade 5 in science) Sport Travel