16-19 Student Application form 2015
Preferred deadline for applications is 30th Jan 2015 Scarborough Sixth Form College Scarborough Sixth Form College Application Form Application Form (If you are over 19 on September 1 2015 please contact admissions for a Mature Student Application Form)1Please returncontact this completed Application (If you are over 19 on September 2015 please admissions for a Form to: Admissions, Scarborough Sixth Form College, Sandybed Lane, Mature Student Application Form) Please return this completed Application Scarborough YO12 5LF Form to: Admissions, Scarborough Sixth Form College, Sandybed Lane, Scarborough YO12 5LF Tel: 01723 380722 Fax: 01723 367049 Email: [email protected] Tel: 01723 380722 Fax: 01723 367049 Email: [email protected] Scarborough Sixth Form College Please attach a passport-size Please attach a Applicationphotograph Form here passport-size photograph here PLEASE COMPLETE IN CAPITAL LETTERS (Please contact us if you require a larger print version of this form) (Please contact us if you require a larger print version of this form) (If you areRegistration over 19 on September Number: 1 2015 please contact admissions for a Mature Student Application Form) Please return this completed Application Registration Number: Form to: Admissions, Scarborough Sixth Form College, Sandybed Lane, Personal Details (Complete unshaded boxes) Scarborough YO12 5LF Scarborough Sixth Form College Personal Details (Complete unshaded boxes) Please attachForm a Application passport-size Name(s): Surname: Tel: 01723First 380722 Fax: 01723 367049 Please state if you have been a student at this college before: YES NO Email: [email protected] First Name(s): Surname: Sex(Male/Female): Date of Birth: (Please contact us if you require a larger print version of this form) Sex(Male/Female): Date of Birth: (If you are over 19 on September 1 2015 please contact admissions for a Address: Mature Student Application Form) Please return this completed Application Registration Number: Address: Scarborough Sixth Form College, Sandybed Lane, Form to: Admissions, Town: Postcode: Scarborough YO12 5LF Personal Details (Complete unshaded boxes) Town: Postcode: School: Tel: 01723Primary 380722 Fax: 01723 367049 First Name(s): Surname: Email: [email protected] Primary School: Secondary School: (Please contact us if you require a larger print version of this form) Sex(Male/Female): Date of Birth: Secondary School: Telephone: Mobile: Registration Number: Mobile: Address:Telephone: Age on 1/9/2015: Email: on 1/9/2015: Personal Details (Complete unshaded boxes)Email: Town: Age Postcode: Parent/Guardian Emergency Contact Details (please do not quote your own mobile no.) not quote your own mobile no.) Parent/Guardian Emergency Contact Details (please doSurname: First Name(s): Primary School: Surname: Title: First Name(s): Surname: Title: First Name(s): Sex(Male/Female): Date of Birth: Secondary School: Contact Tel No. Contact Tel No. Telephone: Mobile: Address:Address Address Age on 1/9/2015: Email: Town: E-mail: Postcode: to you: Relationship E-mail: Relationship to you: Emergency Contact Details (please do not quote your own mobile no.) Parent/Guardian Primary School: Surname: Title: First Name(s): Surname: Title: First Name(s): Surname: Title: First Name(s): Secondary School: Contact Tel No. Contact Tel No. Tel No. Contact Telephone: Mobile: Address Address Address Age on 1/9/2015: Email: Relationship to you: E-mail: E-mail: E-mail: Relationship to you: to you: your own mobile no.) Parent/Guardian Emergency Contact Details (please do not quoteRelationship CollegeFirst staffName(s): use only: College staff use only: Contact Tel No. Title: Address ■ ■ School Report Surname:Parental Consent School Report Parental Consent ■ ■ photograph here Please attach a passport-size photograph here CAREER INTEREST Courses Applied for (this is not a final decision and can be changed at a later date) Courses Applied (thistoisstudy notand a final decision and canBTEC, be changed at a Applied later date) Please list the subjects for you wish indicate levels (AS, AS/A2, or GCSE/Double GCSE). Please list the subjects you wish to study and indicate levels (AS, AS/A2, BTEC, or GCSE/Double Applied GCSE). Courses Applied for (this is not a final decision and can be changed at a later date) CAREER INTEREST Please list the subjects you to study and levels (AS,and AS/A2, BTEC, GCSE/Double GCSE). Courses Applied forwish (this is not a indicate final decision can be or changed at aApplied later date) CAREER INTEREST Please list the subjects you wish to study and indicate levels (AS, AS/A2, BTEC, or GCSE/Double Applied GCSE). CAREER INTEREST CAREER INTEREST d (if applicable) d (if applicable) Board Year Result Board Year Qualifications already gained (if applicable) Subjects: Result Board Year Result Board Year Year Result Result Year Year Result Result Qualifications already gained (if applicable) Qualifications already gained (if applicable) Subjects: Subjects: Qualifications already gained (if applicable) Board Qualifications already gained (if applicable) Predicted Grades Subjects: Board What results are you expecting to get in your GCSEs/BTECs/other qualifications? Subjects: Board Please include any qualifications you have already achieved. No Yes ■ ■ No ■ ourse? Yes ■ e and examining board: GCSEs/BTECs/other qualifications ourse? Grade e and examining board: English Are youLanguage presently GCSE following an AS course? Yes general activities in and out of school. Maths If yes, GCSE please indicate the course title and examining board: general activities in and out of school. ■ GCSEs/BTECs/other qualifications No Grade ■ ■ ■ ■ ■ ■ ■ ■ ■ No Are you presently following an AS course? Yes Additional Information No Are you presently following an AS course? Yes Briefly tell us about your leisure and general activities in and out of school. If yes, please indicate the course title and examining board: If yes, please indicate the course and examining No Are you presently following an AStitle course? Yes board: No Are you presently following an AS course? Yes Additional Information If yes, please the course examining board: Additional Information Briefly tell usindicate about your leisure title and and general activities in and out of school. IfBriefly yes, please indicate theleisure courseand titlegeneral and examining tell us about your activitiesboard: in and out of school. hority or theWhat Leaving Care team? No is your nationality? Yes British Additional Information ■ ■ tellCare us about your leisure and general activities and ................................................................... out of school. Information Briefly Other Please hority or theAdditional Leaving team? Yes ■ No ■instate: s appropriate) Briefly tell us about your leisure and general activities in and out of school. s appropriate) ■ 12 Asian or Asian British - Indian ■ Yes ■ No ■ 12 IfAsian Asian Indian 13 Asian Black Black British British African Black or Asian Black British British -- Pakistani Caribbean ■ 15 ■ 16 Yes,orplease state--the country: .......................................... Ethnicity Code (please tick as appropriate) 15 Any BlackOther or Black British - African 16 Mixed Black or Black and British - Caribbean - White Asian ■ 98 ■ 19 11you Asian or Asian British -Local Bangladeshi 12Leaving Asian or Asian British - Indian Yes ■ ■ 13 Asian No or Asian Areyou the care the LocalAuthority Authority■ the Leaving Care team? Are ininthe care ofofthe ororthe Care team? ■ ■British - Pakistani you in the the Local Authority the -Leaving No ■ 98 Are Any Other 19 or Mixed White andCare Asianteam? Mixed - White andcare BlackofCaribbean 22 any other Mixed BackgroundYes ■ ■ 21 ■ 14 Asian or Code Asian British 15 Black or Black British - African ■ ■ ■ 16 Black or Black British - Caribbean Ethnicity (please tick as 22 appropriate) 21 Ethnicity Mixed -- Irish White Code and Black(please Caribbeantick as Mixed any other Mixed Background White 25 White any other white background ■ 24 ■ appropriate) Are you in the care of the Local Authority or the Leaving Care team? Yes ■ No ■ 17 Black or Black British any other 98 Any Other 19 Mixed - White and Asian ■ ■ ■ 11 Asian or Asian British Bangladeshi 12 Asian or Asian British Indian 13 Asian or Asian British - Pakistani Are you in the care of the Local Authority or the Leaving Care team? Yes No ■ ■ ■ ■ ■ White - IrishBackground 25 White - any other white background White Mixed / multiple Asian/Asian Black / African / ethnic ■ 24■Ethnicity ■ Black 11 Asian or Code Asian British - Bangladeshi or Asian British - Indian or Asian BritishOther - Pakistani ■■1221Asian ■■1322Asian (please tick as appropriate) Mixed -British White and Black Caribbean Caribbean Mixed - any other Mixed ethnic Group / Black groupBackground 14English Asian or Asian British Black or Black British - African Black or Black British - Caribbean ■ ■1515Black ■1616Black 31 /White Welsh Ethnicity (please tick as appropriate) 20Asian Mixed -Asian and Black African British ■ orCode British or Black British - African or Black British - Caribbean ■ ■ Whiteor-39 Irish Whiteor-Asian any other white background / Scottish / British - Bangladeshi 11 Asian or Asian 1224Asian Asian British - Indian 1325Asian British 35 White and■ Black Indian 47- Pakistani Arab ■ ■ ■■14 ■ ■ 17Northern Black or Black British any other 98 Any Other 19 Mixed - White and Asian ■ ■ Irish / Caribbean 44■ African 23Asian White British or Asian British Bangladeshi 12 Asian or Asian British Indian 13 Asian or Asian British Pakistani ■■1117 ■ BlackBackground or Black British any other Any Other Pakistani 19 Mixed - White and Asian Black 98- Any other Asian or Asian British 15 Black or 40 Black British - African 16 Black or Black British Caribbean British ■ 14 ■■98 21 Mixed - White and Black Caribbean 45■ 22 Mixed - any other Mixed Background ■ Black Background 36 White and Caribbean ethnic group I do or notAsian wish British to record my ethnic 1499Asian 15 Black or Black British African 16 Black or Black British Caribbean ■■ ■ ■ 21 Mixed - White and Black Caribbean 22 Mixed - any other Mixed Background 20Black Mixed -Black WhiteBritish and Black African 41 Bangladeshi ■17 32 Irish Black African or any other 98 Any Other 19 Mixed White and Asian ■ ■ ■ group 24 White - Irish 25 White - any other white background Mixed - White and Black African ■1925other ■ 1720 46 Any 99 I do not wish Black or Black British any other 98 Other Mixed White andwhite Asian Black Background ■ ■■ ■ 24 Any White - Irish White -- any other background 42 Chinese 23Gypsy White -or British 33 Irish 37 White and■ Asian Black / African to record my ■Black 21 Mixed White and Black Caribbean 22 Mixed any other Mixed Background ■ Background White - British ■ Traveller Caribbean group 20 Mixed - White and Black African 21 Mixed - White andother BlackAsian Caribbean 22 Mixed - any other Mixedethnic Background ■■23 ■/background 43 Any Any other■ Mixed 99 I do not wish to record my38 ethnic 24 White Irish 25 White any other white background ■ ■ 20 Mixed White and Black African ■ 99 background IAny do not wishWhite to record my ethnic 34 other / multiple ethnic group White - British 24 White - Irish ■ 23 ■ 25 White - any other white background background Group ■ group - British ■ 2399 White ■ I do not wish to record my ethnic I do not wish to record my ethnic ■ 99group 13 Asian or Asian - Pakistani Have you in lived (other than holidays) in British the Care last 3team? years? Are you the outside care of the UK Local Authority or the Leaving group Courses Applied for (this is not a final decision and can be changed at a later date) Please list the subjects you wish to study and indicate levels (AS, AS/A2, BTEC, or GCSE/Double Applied GCSE). Support with your learning We aim to make the college a place where people including those with learning difficulties, disabilities or health CAREER INTEREST problems can attend, learn and whenever necessary and possible, receive additional support. Scarborough Sixth Form College makes every effort to ensure that any support you may need to successfully complete your course is available to you when you start college. To enable us to do this, please complete the following, which is to ensure that we make the very best provision for your needs. Please tick any boxes below which apply to you: I don’t have a learning support need Medical Condition Details (including any medication):......................................................................................................................................... ............................................................................................................................................................................................... ............................................................................................................................................................................................... Qualifications already gained (if applicable) Physical Disability Hearing Impairment Visual Impairment Subjects: Dyslexia/Specific Learning Difficulty Board Condition Autistic Spectrum Year Syndrome Result Asperger’s Mental Health Issues Emotional/Behavioural Issue Any Other Please Specify:....................................................................................................................................................................... ............................................................................................................................................................................................... ............................................................................................................................................................................................... No Are you presently following an AS course? Yes If you have any questions or wish to discuss anything in more detail, please contact Julie Walkington, Learning Support on 01723 380779 IfManager, yes, please indicate the course title and examining board: ■ ■ Personal Interests Additional Information Briefly tell us about your leisure and general activities in and out of school. Communication with Parents/Guardians We view education as a partnership between students, parents and the College. Parents will be contacted at times throughout the academic year, both with standard mailings and if there is thought to be a cause for concern. We will telephone parents and share information about attendance, grades and concerns generally unless we have information or a feeling that to do so would not be in Are you in the care of the Local Authority or the Leaving Care team? Yes No the best interests of the student. ■ ■ Communication with Parents/Guardians Ethnicity Code (please tickbetween as appropriate) Photographs and We view education asImages a partnership students, parents and the College. Parents will be contacted at times throughout the Photographs areboth taken ofstandard all students for ourand enrolment records. of students may be academic year, with mailings if there is thoughtOn to occasions, be a causephotographs for concern. or Wevideos will telephone parents andtaken sharefor promotional purposes (e.g.- Bangladeshi College prospectus, newspaper, College website, and College/departmental displays). 11 Asian or Asianattendance, British 12 Asian or Asian British Indian 13 Asian or to Asian British - Pakistani about grades and concerns generally unless we -have information or that do so would not be in ■information ■ local ■a feeling the best interests of the student. 14 Asian or Asian British ■Consent ■ 15 Black or Black British - African ■ 16 Black or Black British - Caribbean Please sign below to Images give your consent for the following: Photographs and • Black I agree that appropriate, relevant may98be communicated to my parent/guardian(s) staff 17 orare Black British anystudents other Any Other On occasions, 19College Mixed White andmay Asian taken of all for data our■ enrolment records. photographs of -students be taken for ■Photographs ■orbyvideos • I agree that the(e.g. College mayprospectus, use my image and/or personal detailswebsite, in promotional materials and for administration promotional purposes College local newspaper, College and College/departmental displays). Black Background ■ 21 Mixed - White and Black Caribbean ■ 22 Mixed - any other Mixed Background Consent 20 Mixed White and Black African Student Agreement ■Please sign below to give your consent for the following: - Irish White - any of other ■may24ofbeWhite ■ by25toCollege I declare that all information given in support this application is correct and complete the best mywhite background • I agree that appropriate, relevant data communicated to my parent/guardian(s) staff 23 White British ■knowledge and belief at the time of writing. I agree to Scarborough Sixth Form College processing the personal data in this • I agree that the College may use my image and/or personal details in promotional materials and for administration form for any purposes connected with my education, welfare, personal safety or the legitimate interests of the college. ■ 99 I do not wish to record my ethnic Student group Agreement Student’s Signature: Date: I declare that all information given in support of this application is correct and complete to the best of my knowledge and belief at the time of writing. I agree to Scarborough Sixth Form College processing the personal data in this COLLEGE STAFFconnected USE ONLY form for any purposes with my education, welfare, personal safety or the legitimate interests of the college. Date Form Received: Communication with Parents/Guardians We viewwe education as a partnership between students, parents and the College. Parents will be contacted at times throughout the How use your personal information academic year, both with standard mailings and if there is thought to be a cause for concern. We will telephone parents and share The information you provide is passed to the Chief Executive Funding and, information about attendance, grades and concerns generally unless of weSkills have information or awhen feelingneeded, that to dothe so would not be in Department for of Education, including the Education Funding Agency to meet legal responsibilities under the the best interests the student. Apprenticeships, Skills, Children and Learning Act 2009, and for the Agency’s Learning Records Service (LES) Photographs Images to create and and maintain a unique learner number (ULN). The information you provide may be shared with other Photographs are taken offor all purposes students forrelating our enrolment records.or Ontraining. occasions, photographs or videos of students may be taken for partner organisations to education promotional purposes (e.g. College prospectus, local newspaper, College website, and College/departmental displays). Tick this box if you do not wish to be contacted in respect of surveys and research by mail or phone. Consent Please sign below to give your consent for the following: Tick this box if you do not wish to be contacted about courses or learning opportunities by post. • I agree that appropriate, relevant data may be communicated to my parent/guardian(s) by College staff • I agree that the College may use my image and/or personal details in promotional materials and for administration Student Agreement I declare that all information given in support of this application is correct and complete to the best of my knowledge and belief at the time of writing. I agree to Scarborough Sixth Form College processing the personal data in this form for any purposes connected with my education, welfare, personal safety or the legitimate interests of the college. Student’s Signature: Date: COLLEGE STAFF USE ONLY COLLEGE STAFF USE ONLY Date Form Received: Date Form Received: Entered on MIS by: Details checked and data entered into MIS by: Acknowledgement Sent: Ref Request Sent: Date acknowledgement to student and Principal’s letter sent: Date Reference Request sent: Consultation Date: Date: Ref on MIS: Date Reference Request returned/entered into MIS: Date Date:of first consultation: Interviewer’s Signature:Interviewer’s Signature (1st interview): Personal Details Checked: Personal Details checked: Attending S6F Preview? Yes No Country of Domicile where student has been ordinarily resident for the 3 years preceding the start of the programme: Details of evidence produced for international students, Passport: Level: of and typeSubjects: Definitefor example Possible Sample Introduction Course Choices Attending Introduction Course? Level: Subjects: Yes ■ No ■ Bridge the Gap? Definite ■ Possible Sample Notes: Date of Enrolment: Interviewer's Signature (2nd interview): Personal Details checked: NOTES: Yes ■ No ■
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