Tech City College ApplicationForm 2017/18
Section A: Students details
First Name: / SurnameD.O.B: / Male/Female
Address
Post code: / Telephone(s) / Mobile:
Home:
Section B: Parent/Carer/ Guardian Details
Mr/Mrs/Ms/Miss (please circle) Name:Daytime Telephone Number
Work Telephone Number / Mobile
Address / Post code
Email Address
Your relationship to the above child?
Do you have parental responsibility for the above child? YES / NO (Please delete as appropriate)
If No, who has parental responsibility?
Are you leaving independently?YesNo
Do you have a caring responsibility for a parent/ sibling/child/other? YesNo
Are you in, or have you recently left care? *YesNo
*this will enable us to offer you support services where appropriate.
Section C: Current School Information:
Current School / Name:Address:
Telephone Number:
School Entry Date / Attendance Percentage at School
In which local authority is your child’s current school?
UCI/UPN/ULNNumber
Free School Meals Entitlement*: Yes No / You will need to provide evidence of this at your interview/enrolment
Section D: Nationality and residential status
What is your current nationality according to your passport?
What country were you born in?
Have you been a resident of UK/EEA for the 3 years prior to the start of your course? Yes No
If no, in what country did you live in the past 3 years?
D / D / M / M / Y / YDate of entry to UK?
Is English your first language? If no, please state
If you hold a passport outside the European Union, please tick the relevant box below:
Asylum seeker / Refugee / Tier 4 / Indefinite leave to enter or remainHumanitarian protection / Discretionary leave / Exceptional leave / Other
Section E: Ethnicity-Please tick
White Dual heritage Black Asian Other
English/welsh/Scottish/ N.Irish/British / White and Black Caribbean / African / Indian / ArabIrish Background / White and Black African / Caribbean / Pakistani / Any other Ethnic group
Gypsy / Traveler / White and Asian / Any other black background / Bangladeshi
Any other white background / Any other mixed ethnic background / Chinese
Any other Asian background
Section F: Support services
Please ensure you complete this Section if you need support.
Failure to declare learning support requirements may impact on you obtaining sufficient support in order to successfully pass your qualifications.
Do you have a learning disability, sensory impairment or medical condition? / Yes NoDo you have an Educational Health Care Plan / Statement? / Yes No
Do you have a medical condition or health difficulty that may affect your attendance or participation? / Yes No
Do you feel that you will need extra support in your studies for any other reason? / Yes No
School SENCO Contact Details / Name: / Telephone:
Email Address:
If you have answered yes to any of the questions above, please provide details ticking all that apply below. If you would prefer to disclose privately, please tick here.
Visual impairment / Hearing impairment / Disability affecting mobility / Other medical conditions (e.g. epilepsy, asthma, diabetes)Mental health difficulty / Emotional/behavioral difficulties (e.g. ADHS, ADD & EBD) / Profound complex disabilities / Moderate learning difficulty
Severe learning difficulty / Asperger’s syndrome / Autism spectrum disorder / Multiple learning disabilities
Multiple learning difficulties / Other specific learning difficulty (e.g. Dyspraxia, Dyslexia, Dyscalculia / Other
Section G: Qualifications
Have you studies for a qualification you are applying to do here anywhere before, even if you did not complete it?
Yes No
If yes please state qualification, and where you studied this.
Qualification: Where: Date:
Qualifications:
Title / subject / Level (e.g. GCSE, A/AS, Diploma) / Predicted Grade / Actual Grade& Date obtained
Section I:Option ChoicesReserve Choices:
Please note that BTEC/vocational courses will take up two of your option choices.
Please think carefully about your reserve choices. Refer to the enclosed entrance criteria document before making your option choices. These courses will run alongside a compulsory ‘ASPIRATIONS Employability Project which lead to EPQ that will be eligible for UCAS points.
Choice 1Choice 2
Choice 3
Reserve 1
Reserve 2
**Please note that some courses may not run due to lack of demand
Is Tech City College your first choice?If No, where else are you applying for?
Future Progression
Career Choice/ Area of interestSection J:Personal Statement – please include yourreasons for choosing the course what interests you about the subject?
Section K: How did you hear about the College?
Live locally / College website / Previous student / Recommended by friend/familyCollege advertising / Events at the College / Flyer or leaflets / Recommended by school advisor/teachers
Other websites/social media / Outdoor advert: banner/poster / College stand at an external event / College presentation at my school
Section L: Reference
You will need to ask a teacher or employer to fill in a reference form. You can do this by completing the online form which can be found on our website, or by completing a paper based form from the website or the College reception.
Section M: Declaration and Data protection
I understand that I have the responsibility to provide accurate information, and the information I have given is correct to the best of my knowledge. I will update the College if any of my personal details change. I consent for my personal information provided on this application to be recorded, by Tech City College. I understand that the information will be treated in confidence and used internally for specific purposes as laid out in the College’s Data Protection Policy. Some of the information may need to be shared for statistical purposes with College partners such as the Department for Education, Education Funding Agency and the London Borough of Islington.
Applicant signatureName of parent/carer
Signature of parent/carer / Date
Please ensure that this application form is completed and sent electronically to
Interviews will be scheduled following receipt of application forms
Tech City College: Entrance Criteria Summary Guide
There are number of pathways available:
Which pathway have you selected? (Please tick one option)3A / 3 x A level (two year programme)
Entrance criteria: 5x A* - B GCSE /
3B / 1 x Vocational & 1 x A level (two year programme)
Entrance criteria: 2 x A* - C GCSE /
3C / Vocational BTEC Level 3
Entrance Criteria: Merit grade at Level 2 and A* - C in GCSE Maths and English /
3D / Foundation Enterprise Level 2
Entrance criteria: 1 x A* - C GCSE or Level 1 /
3E / Apprenticeship:
- Intermediate at Level 2(equivalent to 5 GCSEs at A*-C)
- Advanced at Level 3(equivalent to 2 A Levels)
3F / GCSE Maths, English & Science