QUALIFICATION DETAILS:
What qualifications do you have or are you working towards?
EXAM DETAILS
QUALIFICATION
TYPE
(Exam Board,
Month and Year)
(e.g. GCSE /
BTEC Level 2 etc)
TO BE COMPLETED AT
REGISTRATION MEETING BY
STANTONBURY STAFF
SUBJECT
ACTUAL
GRADE:
TUTORSplease insert the
STANTONBURY CAMPUS, SIXTH FORM, COOKSEY HALL
APPLICATION FOR ADMISSION - SEPTEMBER 2014
Please complete ALL applicable sections in BLOCK CAPITALS ONLY
APPLICATION FOR EXTERNAL STUDENTS
TOTAL number of GCSE grades:
TOTAL NO OF A*s
=
TOTAL NO OF As =
STUDENT DETAILS:
Legal Surname:
Middle name(s):
Surname known
as:
Address:
Home Telephone:
TOTAL NO OF Bs =
TOTAL NO OF Cs =
Forename:
Student Mobile:
TOTAL NO OF Ds =
Student email:
TOTAL NO OF Es =
TOTAL NO OF Fs =
Postcode:
Gender:
TOTAL NO OF Gs =
Date of Birth:
How old will you be
on 1st September?
M / F (please circle)
1ST PARENT OR CARER IN RESIDENCE AT ABOVE ADDRESS:
Surname:
Forename:
Title:
Relationship to
student:
Address:
Gender:
M / F (please circle)
Home Telephone:
Mobile:
Postcode:
MEDICAL / SPECIAL NEEDS DETAILS:
Health Centre:
Telephone Number:
Address:
Do you have any medical
conditions?
Yes / No
Do you have dyslexia /
spelling problem?
Yes / No
Work Telephone:
Order of contact
email:
1st / 2nd / 3rd (Please circle)
in an
emergency:
ND
2 PARENT OR CARER
IF THIS IS A PARENT LIVING ELSEWHERE, WILL THEY REQUIRE REPORTS?
Surname:
Forename:
Title:
Relationship to
student:
Address:
Gender:
Have you ever
had a statement of
special needs?
Yes / No
Are you visually
impaired?
Yes / No
Are you hearing impaired?
Yes / No
Home Telephone:
Do you have
mobility
difficulties?
Yes / No
Are there other aspects of
learning we should know
about?
Yes / No
Mobile:
Have you ever
received support?
Yes / No
If the answer is ‘YES’ to any of the above, please specify:
Postcode:
Order of contact:
M / F (please circle)
Work Telephone:
1st / 2nd / 3rd (Please circle)
email:
OTHER CONTACT
IF NOT RESIDENT WITH THE STUDENT THEN THE ADDRESS AND TELEPHONE NUMBER MUST BE PROVIDED FOR DATABASE PURPOSES
Surname:
Forename:
Title:
Relationship to
student:
Address:
Gender:
Home Telephone:
Applicant’s Signature: ___________________________ Date: ________________
Return to: Student Services, Stantonbury Campus, Milton Keynes, MK14 6BN
Yes / No (please cicle)
Postcode:
Order of contact:
Mobile:
1st / 2nd / 3rd (Please circle)
Work Telephone:
M / F (please circle)
Academic Route:
Nearly all A*-B at GCSE
Mixed Route
Average GCSE grades around B-C
Vocational Pathways
EDUCATION DETAILS: DETAILS OF SECONDARY SCHOOLS AND COLLEGES ATTENDED:
DATE (FROM – TO)
1.
2.
3.
4.
5.
6.
7.
8.
Option Block A
Option Block A
Option Block A
1.
Business Studies
Communication and Culture
English Literature
French
Government and Politics
ICT
Physics
Sociology
2.
3.
4.
5.
Art and Design BTEC National Extended
Diploma (must be selected in blocks A, B
and D)
Creative Media Production BTEC National
Diploma (must be selected in blocks A and
B)
Health and social Care Single Award
Sport: Development, Coaching and Fitness
BTEC Diploma (must be selected in blocks A
and D)
Information Technology BTEC
1.
2.
3.
4.
5.
Option Block B
1.
2.
3.
4.
5.
6.
7.
8.
Biology
Design and Technology: Product
Design 3D
Economics
English Literature
History
Music
Psychology
Sociology
Option Block B
1.
2.
3.
4.
5.
6.
Applied Business Studies Double Award (must
be selected in blocks B and C)
Applied Science BTEC National Subsidiary
Diploma
Art and Design BTEC National Diploma (must
be selected in blocks B and D)
Creative Media Production BTEC National
Diploma (must be selected in blocks A and B)
Design and Technology: Product
Design 3D
Performing Arts BTEC Extended Diploma
(must be selected in blocks B, C and D)
Option Block B
1.
2.
3.
4.
5.
6.
Option Block C
1.
2.
3.
4.
5.
6.
7.
8.
9.
Art and Design
Biology
Business Studies
Geography
History
Maths
Maths GCSE re-take*
Psychology
Theatre Studies
Art and Design BTEC National Extended
Diploma (must be selected in blocks
A, B and D)
Communication and Culture
Creative Media Production BTEC
National Diploma (must be selected in blocks
A and B)
Health and social Care Single Award
Sport: Development, Coaching and Fitness
BTEC Diploma (must be selected in blocks
A and D)
Information Technology BTEC
Option Block C
1.
2.
3.
4.
5.
6.
7.
8.
9.
Applied Business Studies Single Award
Art and Design
Communication and Culture
English GCSE re-take*
History
Maths GCSE re-take*
Performing Arts BTEC Extended Diploma (must
be selected in blocks B, C and D)
Sport: Development, Coaching and Fitness
BTEC Extended Diploma (must be selected in
blocks A, C and D)
Theatre Studies
5.
1.
2.
NB. We will need to contact your current or most recent school or college for a reference.
Please sign/print your name here to confirm you give us your permission to do so:
HAVE YOU EVER BEEN A STUDENT AT STANTONBURY CAMPUS?
Yes / No (please circle )
APPLICATION DETAILS:
Please give relevant details to support your application. Include information about the courses you particularly
wish to study and why; and previous education (e.g. long periods of time missed through illness, any education
abroad, any examinations taken other than detailed to be given on back page (please feel free to use an extra sheet
of paper if required)
Applied Business Studies Single Award
English GCSE re-take*
Maths GCSE re-take*
Performing Arts BTEC Extended Diploma
(must be selected in blocks B, C and D)
Sport: Development, Coaching and Fitness
BTEC Extended Diploma (must be
selected in blocks A, C and D)
PROPOSED CAREER:
What do you hope to do after completing this course?
COURSES AGREED AT APPLICATION MEETING (TO BE COMPLETED BY STANTONBURY CAMPUS STAFF)
Route of
preference
(subject of
grades)
Please
circle1st,
2nd and3rd
Option Block D
1.
2.
3.
4.
5.
6.
7.
8.
Chemistry
Communication and Culture
Computing
Dance
Government and Politics
Maths
Music Technology
Psychology
Option Block D
1.
2.
3.
4.
5.
6.
7.
8.
9.
Art and Design BTEC National Diploma (must be
selected in blocks B and D)
Communication and Culture
Creative Media Production BTEC National
Extended Diploma (must be selected in Blocks
A, B and D)
Dance
Financial Studies
Health and Social Care Double Award (must be
selected in blocks A and block D)
Music Technology
Performing Arts BTEC ExtendedDiploma (must
be selected in blocks B, C and D)
Sport: Development, Coaching and Fitness
BTEC Diploma (must be selected in blocks A
and D)
Option Block D
1.
2.
3.
4.
5.
6.
7.
8.
NAME AND ADDRESS OF SCHOOL / COLLEGE
Applied Business Studies Double Award (must
be selected in blocks B and C)
Applied Science BTEC National Subsidiary
Diploma
Art and Design BTEC National Diploma (must
be selected in blocks B and D)
Creative Media Production BTEC
National Diploma (must be selected in blocks
A and B)
Design and Technology: Product
Design 3D
Performing Arts BTEC Extended Diploma (must
be selected in blocks B, C and D)
Option Block C
1.
2.
3.
4.
NAME OF TUTOR
Art and Design BTEC National Diploma (must be
selected in blocks B and D)
Communication and Culture
Creative Media Production BTEC National
Extended Diploma (must be selected in Blocks A,
B and D)
Financial Studies
Health and Social Care Double Award (must be
selected in blocks A and block D)
Music Technology
Performing Arts BTEC ExtendedDiploma (must
be selected in blocks B, C and D)
Sport: Development, Coaching and Fitness BTEC
Diploma (must be selected in blocks A and D)
Academic
Route
1st 2nd 3rd
Mixed
Route
1st 2nd 3rd
Vocational
Route
1st 2nd 3rd
Block A
Block B
Block C
Block D
Block A
Block B
Block C
Block D
Block A
Block B
Block C
Block D
INTERVIEW DETAILS (TO BE COMPLETED BY STANTONBURY CAMPUS STAFF)
FIRST APPLICATION MEETING DATE AND TIME:
SECOND APPLICATION MEETING DATE AND TIME:
NAME OF STAFF CONDUCTING MEETING:
RELEVANT COMMENTs: