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year 12 enrolment 2020/21

Please complete all details on this form carefully and ensure you upload a copy of your GCSE results.

Please ensure you have consulted the entry requirements available in the prospectus.

Surname* Forename* School attended*

Proposed courses

Please select from the lists below the three subjects you wish to study at A Level for the two years you will be with us.

You can also choose to study EPQ or Mathematical studies alongside your A Levels during Year 12.

Please upload a copy of your GCSE results* No file chosen

Personal Details

Legal Surname* Legal Forename* Preferred Forename Home telephone number Mobile Telephone Number* Personal email address* Date of Birth* This must be a head and shoulders view only with a plain background* No file chosen House Number or Name* Street Name* Address Line 2 Town* Postcode*

Parent/Guardian Details

Contact 1*

	Title	First Name	Surname	Relationship to Student

Address Details*

	House Number or Name	Street	Address 2	Town	Postcode

Contact details*

	Home Tel	Work Tel	Mobile Telephone	Email

Does this person have legal parental responsibility?*YesNo

Contact 2*

	Title	First Name	Surname	Relationship to student

Address Details*

	House Number or Name	Street	Address 2	Town	Postcode

Contact details*

	Home Tel	Work Tel	Mobile Tel	Email

Does this person have legal parental responsibility?*YesNo

Data Collection Information

Please complete all sections

Do you have any special education needs?*YesNo

If you answered yes above, please provide details:

Is English your first lanaguage?*YesNo

Home Language*

This question about first language is not related to whether you speak English well. Your first language is the language you were first exposed to at the ages 0 to 5 in the home or in the community and which you either still speak or hear at home or in the community.

Ethnicity* Religion Country of Birth* Nationality*

Have you had any special arrangements for exams*YesNo

Have you received Free School Meals in the last three years*YesNo

Medical Details

Name of Doctor Medical Practice* Telephone Number* Please provide details of any medical conditions we need to be aware of:

Destination after Sixth Form

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