First name(s)
Please read the ‘Choosing a School’ and ‘Secondary School Admissions Policy’ booklets before you complete this form.
The booklets are available at www.salford.gov.uk/school-admissions-online or by ringing 0161 909 6508. You can also apply online at www.salford.gov.uk/school-admissions-online
(please complete in block capitals)
Surname
Gender Male Female Date of birth
Child’s home address:
Current secondary school:
Postcode
Does your child have a Statement of Special Educational Needs? Yes No
Is your child in the care of a local authority or was your child previously
Looked After and is now adopted or under a special residence or guardianship order? (Looked after Child/Child in care)
Yes No
If yes, please state the name of the local authority your child was/is in care to.
Does your child have a social worker? Name:
Local Authority:
Contact details:
For office use only
Student ID:
Is your child new to the country?
If yes, please state country of origin and date of arrival in the UK
What is your child’s first language?
Is your child a refugee or asylum seeker?
Is your child a traveller?
Yes
Country of origin:
Date of arrival in UK:
Yes
Yes
No
No
No
DATA PROTECTION ACT: Salford City Council is registered with the Information Commissioner for processing personal data in compliance with current legislation. Any information you provide will be used to monitor services that are provided to you and your child by Salford schools and the local authority. It will be used to compile statistics on the school careers and experiences of pupils, in order to help ensure that all pupils have the opportunity to fulfil their potential. From time to time the information will be passed on to the Department for Education (DfE) to contribute to local and national statistics. The information will also be passed on to future schools to save people being asked for it again.

(please complete in block capitals)
Title (please tick)
First name(s) or initials
Mr
Relationship to child
Mrs Miss
Daytime telephone number:
Email Address: please print to ensure that no errors are made)
Parent/carer’s home address (if different from child’s):
Ms
Surname
Postcode
Council tax reference number:
(We use this information to help us identify and verify your address)
If we need to contact you regarding this application what is your preferred method of contact? email telephone
Do you have parental responsibility for the child? i.e. are you legally entitled to make decisions on the child’s behalf?
Yes No
If no, please provide details of the person with parental responsibility below:
Title (please tick)
First name(s) or initials
Relationship to child
Mr Mrs
Daytime telephone number:
Email Address: (please print to ensure that no errors are made)
Parent/carer’s home address (if different from child’s):
Miss Ms
Surname
Postcode
Please ensure that you have carefully read the admission criteria for this school. Applicants are grouped by zone based on your home address and places are randomly allocated within each zone. No c onsideration is given of a child’s achievement in a particular area and it is not necessary to provide examples of work.
Please include here any further information which is relevant to your application. You may continue on a separate sheet if necessary. If you are applying after the closing date, please give reasons for why your application is late.

Please indicate your preferred choice of course by numbering each course, where 1 = preferred course and 4 = least preferred course
TV and film
Graphics and Design
Radio and Audio
Interactive Media and Gaming
Please be aware that a place on a particular course cannot be guaranteed even if a place is offered at
UTC@MediaCityUK as course numbers are limited. You should not relinquish a place at your current school until it has been confirmed that a place is both available for your child at UTC@MediaCityUK and there is a place available on their chosen course. Course choices will only be allocated by the
UTC following the allocation of a place at the UTC. Your course choice will not influence whether you are offered a place at the UTC or not. All places at the UTC are solely offered on the basis of the published admission criteria.
 I have read the ‘ Choosing a School’ booklet

I have parental responsibility for the child or I have given details in section 2 of the person who does have parental responsibility for this child.

If applying after the closing date , I have given reasons for why my application is late.

The information given is true and accurate to the best of my knowledge and belief. I understand that any false or deliberately misleading information given on this form and in any supporting information may lead to the offer of a school place being withdrawn. ( Please note : you will be asked to provide proof of your address when you are offered a school place)
Signature of parent/carer
Date
31 October 2015.
nd
This form will be acknowledged within ten working days of receipt. If you do not receive an acknowledgement please call 0161 909 6508 as soon as possible.