Name and Address of School:
Cardinal Pole Catholic School, 205 Morning Lane, London, E9 6LG
SUPPLEMENTARY INFORMATION
(When completing the form, please refer to the oversubscription criteria and interpretation of terms).
The Parent should complete questions 1 to 7 and the Priest should complete the Priest’s Reference
form. If the parent is applying under priority 7 of the oversubscription criteria, this form should be completed up to
question 7 only and a letter of support from a religious leader should be attached
to the form.
Please note that the school receives over 500 applications for 180 places. Completion of this form is
an essential part of the selection process.
Child’s Details
Child’s surname:
Child’s Christian or other first name:
Home Address:
Date of Birth:
Postcode:
Present school
Parent/Carer Details
Parent(s)/Carer(s) name:
Address (if different from
above):
Telephone number:
Alternative contact details:
Name:
Address:
Telephone number:
Details of Religion
Religion of child:
(Please tick)
Catholic
Other Christian
(name of
denomination
e.g Methodist)
Other faith
Catholic Parish you live in:
Church where child was baptised and date of baptism: Please
attach a photocopy of your child's Baptismal Certificate.
Name and position of priest or religious leader supplying
reference (where appropriate) :
Names of brothers or sisters at this school:
Name
Is your child ‘looked after’ by the Local Authority,
adopted or subject to a ‘child arrangements’ or special
guardianship order having previously been ‘looked after’?
(Please circle)
Class or Year Group
YES
NO
Does your child have exceptional medical, pastoral or social needs that can only be met by attendance at
this school? Please circle. (Professional evidence will be required.)
YES
NO
I confirm that I have read and understood the Admissions Policy and that the information I
have provided is correct. I understand that I must notify the school immediately if there is any
change to these details and that should any information I have given prove to be inaccurate
that the governors may withdraw any offer of a place even if the child has already started
school.
Signed………………………………………………………………
Please note:

Date…..…………………
Where applicable parents can obtain a priest’s reference form from the school or from the Diocese
of Westminster website at www.rcdow.org.uk/Education Follow Guidance & Policy Documents,
Admissions: Guidance notes and reference form for priests.
 Applicants from other Christian denominations and other faiths may attach a reference from their
minister or religious leader.
 You must complete your local authority’s Common Application Form and return it to the council
offices by the closing date. If you do not do this you will not be offered a place
Checklist:
Have you enclosed?
Copy of baptism certificate
Priest’s Reference Form (where necessary)
Evidence of exceptional need (where appropriate)
Have you completed your local authority’s Common Application form
PRIEST’S REFERENCE
(TO BE RETURNED TO THE SCHOOL)
To be completed by the parents:
8
Name of Child:
9
Name of Parent(s):
10
Home Address:
11
Post code
12
Telephone:
To be completed by the priest giving the reference:
13
The parents are known to me:
Yes / No
14
The child is known to me:
Yes / No
15
The child is a member of a practising Catholic family:
Yes / No
16
I support this application:
Yes / No
17
If the answers to Q15 and Q16 are not the same, and you think there are exceptional circumstances to
explain this, please give your reasons below:
Declaration
I have read and understood the Guidance Notes for Parish Priests on Admission to Catholic Schools and I
confirm that, on the basis described in that guidance, the above statements about the child named above
and his or her family’s practice are true, to the best of my knowledge and belief.
Date:__________ Priest’s Name:_______________________ signed:________________________________
Parish Seal
(to be applied over the priest’s signature)
Parish Priest’s Countersignature (only where the Parish Priest is not giving the reference): I confirm
that the child is resident in my parish.