For Staff Use Only
Staff Interviewing:
Date of Interview:
Nunthorpe
Sixth Form
Offer to be sent:
Alternative IAG Given:
Application Form
September 2016
Application for a full-time course starting
September 2016 at Nunthorpe Sixth Form
Surname:
First Name(s):
Date of Birth:
Address:
Male
Female
Home Phone:
Email:
Postcode:
Mobile:
Current School/Academy:
Tutor Group:
Completed application forms
should be returned to:
Ms H Jackson
Nunthorpe Academy
Guisborough Road
Nunthorpe
TS7 0LA
Phone:01642 304550
Closing Date:
Friday 13 November 2015
You need to answer the questions in this section very carefully. This will provide important
information that will stay with you for the duration of your time at sixth form. If there are any
questions you are unable to answer then please use ‘N/A’.
Personal Details
Home Language:Nationality:
Religion:
Have you been a permanent resident in the UK for the last three years?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
If no, please specify country:
Do you have any health problems?
If yes, please give details:
Do you require any extra support or facilities?
If yes, please give details:
Do you have any additional educational requirements?
If yes, please give details:
Have you ever received a free school meal in Year 6 to Year 11?
Enrichment/Extra Curricular
What activities have you completed to date to support your career path?
What other Enrichment activities would you like to follow, in addition to your courses?
Parent/Carer Contact Details
Name of Parent/Carer:
Emergency contact phone number: Mobile
Relationship to emergency contact:
Parental email:
Home
Your Exam Results
Please list all the examination subjects you have taken already or will have taken before the start of your
course. Please ensure you include predicted grades for any examinations you have not yet taken.
Qualifications
Type of qual eg
GCSE/BTEC
Level (Higher, Subject/Course
Int, Found)
Your Course(s)
Please indicate here which subjects you would like to study:
Option A:
Option B:
Option C:
Option D:
Your Career
If you know which career you are interested in, please tell us here:
Predicted
Grade
Result/Grade
if known
Course Information
Level 3 courses for students (A levels and BTEC)
Students should be on target for achieving 5 or more A* - C grades at GCSE. All students will be
considered for Level 3 courses but we will only offer places to those who we feel are capable of getting
final grades in those subjects. Please check entry requirements for each subject in the Course Directory.
Subjects
nArt
nHistory
n
Biology
nLaw
n
Business Studies
nMathematics
nChemistry
n
Computer Science
nDrama
n
Media Studies
nMusic
n
Music Technology
n
English Language
n
Philosophy and Ethics
n
English Literature
n
Physical Education
nFrench
n
Further Mathematics
nPhysics
n
Product Design
nGeography
nPsychology
nGerman
nSociology
n
Government and Politics
nSpanish
n
Health and Social Care
nSport
Your Agreement
In accepting a place at the sixth form you must agree to co-operate with the guidelines as stated in the
prospectus and the student learning agreement. You will be required to attend Induction Days, week
commencing 4 July 2016 (please avoid holidays during this week).
Data Protection Act 1998
I agree to the Sixth Form processing personal data contained in this form, or other data which the
Academy may obtain from me or other people, whilst I am a student. I agree to the processing of
such data for any purposes connected with my studies or my health and safety whilst on the premises
or for any other legitimate reason. Information you provide on this application form will be passed
to the Learning and Skills Council, which is registered under the Data Protection Act 1998. The
registration is primarily for the collection and analysis of statistical data but also allows the LSC to share
information with other organisations for the purposes of detecting fraud. Further information about data
confidentiality is available on request from the institution at which you are enrolling.
Please sign this form and return to the address on the front cover:
Signed Date