14 - 16 Courses for Schools
APPLICATION FORM 2014 - 2015
(To be returned to your school)
Schools should return this application form together with the school reference form by Friday 21st March 2014
to: Val Orchin, Plumpton College, Ditchling Road, Plumpton, East Sussex BN7 3AE.
Interviews commence Tuesday 22nd April 2014 at the course venue.
Please complete all sections. Incomplete forms will be returned and may delay your application.
Name of School attending:
APPLICANT DETAILS
Surname:
Male / Female (circle)
Forenames:
Address:
Post Code
Tel. No. (home)
Applicant’s mobile
Applicant’s email
Name(s) of person(s) you live with for correspondence
EMERGENCY CONTACTS Names of parents / carers / next of kin
Mr/Mrs/Miss/Ms/Other
First Name
Surname
Relationship to applicant
Contact tel nos. (work/mobile)
Email
Mr/Mrs/Miss/Ms/Other
First Name
Surname
Relationship to applicant
Contact tel nos. (work/mobile)
Email
SV1/Application form
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Nationality:
ETHNIC ORIGIN (Please ✓)
White
Asian/Asian British
English/Welsh/Scottish/Northern Irish/British
Indian
Pakistani
Irish
Bangladeshi
Chinese
Gypsy or Irish Traveller
Any other Asian background
Date of Birth:
Any Other White Background
Black /African/Caribbean/Black British
Mixed/Multiple Ethnic Group
White and Black Caribbean
African
Age (as at 31.8.14):
Caribbean
Any other Black/African/Caribbean background
White and Black African
Other Ethnic Groups
White and Asian
Any other Mixed/Multiple Ethnic background
Arab
Any other ethnic group
Do you have a learning difficulty or disability? (Please ✓)
YES
*
dyslexia
disability affecting mobility
dyscalculia
other physical disability
*
other specific learning difficulty
*
statement of educational nee
ds (please attac
autistic spectrum disorder
*
emotional/behavioural difficulties*
aspergers syndrome
wheelchair user
ADHD
moderate learning difficulty
dyspraxia
visual impairment
*
epilepsy*
asthma
temporary disability after illness
diabetes
*
heart or lung condition
*
*
hearing impairment
other medical condition
eg. Allergies/skin disorder
*
severe learning difficulty
*
NO
multiple learning difficulties
*
*
*
mental illness
*Please provide further details:
MEDICAL INFORMATION
Have you had a tetanus injection? (Please ✓)
YES
NO
YES
NO
(RECOMMENDED FOR ALL COURSES)
Are you awaiting any surgical operation or hospital appointment? (Please ✓)
Date:
Details:
DETAILS OF YOUR DOCTOR
Name:
Tel. No:
Address:
Post Code
SV1/Application form
2
14 - 16 COURSES FOR SCHOOLS – SEPT 2014 START
Course details and availability
Select Level and Course
with a Tick
Level 1
Level 2
Please tick (✓)
Please tick (✓)
Write nominated day in box below
PLUMPTON MAIN SITE: Years 10/11 - Day Release 14-16
h)
Agriculture
Monday or Tuesday
Countryside & Environment
Monday or Tuesday
Creative Metal Crafts
Monday or Tuesday
Fish Husbandry
Monday or Tuesday
Not available
Forestry
Monday or Tuesday
Not available
Floristry
Monday or Tuesday
Game Management
Monday or Tuesday
Horse Management
Monday or Tuesday
Horticulture
Monday or Tuesday
Machinery Maintenance
Monday or Tuesday
Motor Vehicle Maintenance
Monday or Tuesday
Outdoor Adventurous Activities
Monday or Tuesday
Small Animal Management
Monday or Tuesday
Not available
Not available
Not available
Not available
Not available
Not available
Not available
IVYLAND FARM, NETHERFIELD: Years 10/11 - Day Release 14-16
Level 1
Level 2
Please tick (✓)
Agriculture
Wednesday
Not available
Small Animal Care
Thursday
Not available
Horticulture
Thursday
Not available
Explorer Yr 10 (1 day)
Monday
Not available
Explorer Yr 10 (2 days)
Monday and Wednesday
Not available
Tracker Yr 11 (1 day)
Tuesday
Not available
Tracker Yr 11 (2 days)
Tuesday and Friday
Not available
Mixed School Release
(1 day: Roll On / Roll Off)
Tuesday
Not available
FLIMWELL: Years 10/11 - Day Release 14-16
Woodland Studies
Wednesday
Countryside & Environment
Wednesday
Level 1
Level 2
Please tick (✓)
Please tick (✓)
Not available
Not available
CRABBET PARK: Years 10/11 - Day Release 14-16
Horse Care
Tuesday
FOUNDATION PATHWAYS: Years 10/11 - 9.15am to 12.45pm 14-16 (Level 1 Units only)
10 week blocks
Animal Care
Wednesday
Farm Livestock
Wednesday
Tree Care & Forestry
Wednesday
Horse Care
Wednesday
Horticulture
Wednesday
Creative Metal Crafts
Motor Vehicle
Outdoor Adventurous Activities
Block 1 (Sept to Dec)
Plumpton
Ivyland
Block 2 (Jan to Mar)
Plumpton
Ivyland
Block 3 (Apr to June)
Plumpton
Ivyland
Not available
Not available
Not available
Wednesday
Not available
Not available
Not available
Wednesday
Not available
Not available
Not available
Wednesday
Not available
Not available
Not available
6 TH FORM DAY RELEASE COURSES: 16+ (Level 2 only)
Write nominated day in box below
Countryside & Environment
Monday or Friday
Forestry
Monday or Friday
Horse Management
Monday or Friday
Horticulture
Monday or Friday
Vehicle Technology
Monday or Friday
Please note a completed application form does not confirm entry on to the course.
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SV1/Application form
Do you receive free school meals?
YES
NO
Why have you chosen this College course and what are your expectations of the course?
Detail any career aims.
How do you think College will differ from school?
What are your interests/hobbies?
PARENT/CARER, LEARNER AND SCHOOL DECLARATION
If
(name of applicant) is offered a place on the course:
•
I acknowledge that the Home School ultimately has responsibility for the learner whilst at Plumpton College. Plumpton
College reserves the right to exclude from the course any learner who fails to meet an accepted standard of behaviour.
All discussions, agreements and communications relating to discipline will be made via the Home School.
•
I consent to my son/daughter taking part in all activities which form part of the course, including offsite visits with
College staff.
•
I consent to my son/daughter travelling independently to and from College/Outcentre.
•
I give permission for photographs/video clips to be taken of my son/daughter for the purposes of
marketing/advertising/administration.
•
I understand that my son/daughter will be unsupervised during lunch and break times.
•
I agree to Plumpton College processing personal data or other data about my son/daughter which the college may
obtain from me or other people whilst he/she is a student. I agree to the processing of such data for any purposes
connected with his/her studies or his/her health and safety whilst on the premises or for any other legitimate reason
directly concerned with his/her education.
•
I acknowledge that whilst my son/daughter is on the course I have responsibility to ensure regular attendance and
compliance with the College’s Code of Conduct.
Parent/Carer Signature
Date
Learner Signature
Date
School Coordinator Signature
Date
SV1/Application form
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