Dormers Wells High School
6th Form
For Admission September 2017
External Applicant
Please type or write in BLOCK CAPITALS and in BLUE or BLACK ink
Student Details
Surname: / ………………………… / Preferred Surname: / ……………………………
Forename: / ………………………… / Chosen Name: / ……………………………
Date of Birth / ………………………… / Gender ……………………….
Nationality / …………………………
Address / …………………………………………………………………………………….
…………………………………………………………………………………….
……………………………………………………………………………………..
Post Code / …………………………………….
Home Telephone ……………………………….. / Mobile …………………….
Email Address ………………………………………………………..
Do you have siblings/relatives who presently attend DWHS?
Name: ………………………... Year:…..Name:…………………….. Year:….
Home Language ………………………………………………………..
Other Languages ………………………………………………………..
Current/ Previous School / …………………………………………………………………………
Date from / ………………. / Date to / ………………..
Address / ……………………………………………………………………………
……………………………………………………………………………
DWHS Sixth Form Course Offer
Indicate which courses/subjects you wish to enrol onto in the 6th Form if offered a place.
- BTECS
Please choose one BTEC course.
Please note that you cannot combine a BTEC with any other subject.
Level 3BTEC Extended Diploma in Business Studies
BTEC Extended Diploma in Health & Social Care
- A LEVELS
Please select 3 subjects that you would like to study from the columns below.
You can only choose one per column:
A / B / C / DArt & Design / Biology / Chemistry / Chemistry
Biology / Business / Geography / Computing
Economics / French / History / Maths
English / Maths / Physics / Photography
Maths / Media Studies / Psychology / Psychology
Physical Education / Religious Education / Sociology
Spanish
Has anyone in your family been to University? Yes/No
Have any of your parents completed a HE degree or equivalent course? Yes/No
Please describe your interests and hobbies, e.g. sport, musical ability, drama, student council, posts of responsibility. Try to explain how these activities have helped develop your skills and qualities such as team work, leadership, reliability (no more than 500 words):
What are your career aspirations after completing this course? ie University, employment etc. How will this course help you with your future? (no more than 500 words)
Reference(To be completed by current school/college)
Qualifications
Subject / Level/Qualification / Grade / Predicted/achieved / DateUCI Number / ……………………….. / ULN Number / …………………………….
UPN Number / ………………………..
Personal Qualities
Excellent / Good / Satisfactory / Some concern / Serious concernOrganisation
Work Ethic
Behaviour
Ability to meet deadlines
Ability to take direction
Ability to work with others
Attendance / %
Punctuality / %
Has this student been excluded from Year 10 or Year 11? / Yes / No
If yes, please give details and number of days
Suitability for chosen course(required)
Signed on behalf of the School:School stamp
Name: / ______Position: / ______
Contact Phone Number / ______
Email address / ______
Date / ______
Student Data
Mother/CarerSurname / ______/ Forename / ______
Is this person already on the school database? Yes/No
Address / ______
Post Code / ______/ Email ______
Does the student live at this address? Yes / No
Home phone / ______/ Mobile / ______
Work phone / ______/ Work hours / ______
Which is the most likely contact number during the day? / Home / Mobile/ Work
Parental Responsibility? Yes / No / Court Order Yes / No
Relationship: (Please Tick)
Mother / Other relative
Step parent / Other family member
Foster parent / Carer
Father/Carer
Surname / ______/ Forename / ______
Is this person already on the school database? Yes/No
Address / ______
Post Code / ______/ Email ______
Does the student live at this address? Yes / No
Home phone / ______/ Mobile / ______
Work phone / ______/ Work hours / ______
Which is the most likely contact number during the day? / Home / Mobile/ Work
Parental Responsibility? Yes / No / Court Order Yes / No
Relationship: (Please Tick)
Father / Other relative
Step parent / Other family member
Foster parent / Carer
Please describe any Special Needs which the school should be aware of:
Do you have any dietary needs/allergies:
FAMILYDOCTOR / PRACTICE
Name / ______
Address / ______
______
______
Phone / ______
Travel Arrangements
Please indicate your usual mode of transport to the school site (tick one only)Bicycle / Train / Car/Van / Walk / School Bus / Car Share
London Underground / Public Bus Service / Metro/Train/Light Rail / Other
Photographs and videos
From time to time we use photographs and films of our students for publicity purposes in brochures, films, pamphlets, our website and other educational websites that we contribute towards.
We would like your permission to use your picture should the need arise.
□I agree for photos and moving images of myself to be used in brochures, web pages, the press etc.
Student / Father / Mother
Country of Birth
Date of first arrival in this country
Language name / Speak / Read / Write
First Language / Y/N / Y/N / Y/N
Any other language(other than English) / Y/N / Y/N / Y/N
Any other language(other than English) / Y/N / Y/N / Y/N
Any other language(other than English) / Y/N / Y/N / Y/N
Number of Years in School
In Britain / Abroad
Length of time taught the full curriculum in the English Language(in an English Medium School)
/ Asylum seeker / / Parent in Armed Services
/ Refugee / / Looked after child
/ Care Leaver