Date Received: Year 10 ( ) Year 12 ( )

NEW ENTRANT FORM - SEPTEMBER 2014 START

Please return your completed form to:
Admissions, BTE Academy, New Road, Stoke Gifford, South Gloucestershire BS34 8S!
Or by e-mail to: admissions"#teacademy!co!uk


:
$ntended %ear Grou& 'delete as a&&ro&riate()
1. Student Details
Legal Surname:
Male / Female Date of Birth:
Home Address:
Postcode:
Home telephone:
Mobile telephone (Student:
Mobile telephone (Parent:
!his information ma" be stored on a computer and# if so# it is sub$ect to the Data
Protection Act %&&'( )t *ill not be gi+en to an"one else *ithout "our consent(
,ou ha+e a right to e-amine# at an" reasonable time# information about "ou or
"our child *hich is .ept on a computer and correct an"thing *hich "ou feel is
*rong or misleading(
/hosen Surname:
Legal Forename(s:
/hosen Forename(s:
0ffice use onl"
!utor 1roup:
%ear *+ , %ear *-
.lease &ro/ide details of your current School)
.rimary School)
Please give details of all "persons with parental responsibility" (Children Act
1989) and anyone else who you wish us to contact in an emergency. Please
place them in the order you wish us to contact them.
Order of
Contact
Personal Details
1 2ame: Mr/Mrs/Ms/Miss
Home Address:
Home !el( 2o(:
Mobile:
Da"time /ontact Details (*or.:
3mail address:
4elationship to
/hild:
Parental
4esponsibilit"5
,3S / 20
2 2ame: Mr/Mrs/Ms/Miss
Home Address:
4elationship to
/hild:
6
2ame:
Address:
Telephone:
Dates attended: From__________ To____________
2ame:
2. Parental esponsibility
Home !el( 2o(:
Mobile:
Da"time /ontact Details (*or.:
3mail address:
Parental
4esponsibilit"5
,3S / 20
! 2ame: Mr/Mrs/Ms/Miss
Home Address:
Home !el( 2o(:
Mobile:
Da"time /ontact Details (*or.:
3mail address:
4elationship to
/hild:
Parental
4esponsibilit"5
,3S / 20
" 2ame: Mr/Mrs/Ms/Miss
Home Address:
Home !el( 2o(:
Mobile:
Da"time /ontact Details (*or.:
3mail address:
4elationship to
/hild:
Parental
4esponsibilit"5
,3S / 20
NB) 0e are a#le to send co&ies of re&orts,newsletters etc to any &arent,&erson with &arental
res&onsi#ility who does not reside with the student! $f you ha/e su&&lied more than one
address a#o/e, do you wish this to ha&&en1 %ES , N2
7
8
". #unchtime $rrangements
#i%ely #unchtime $rrangements &please tic%'(
M" child *ill bring a pac.ed lunch 9 :
;ill bu" a meal at the Academ" 9 :
3ntitled to a free meal< 9 :
2ot currentl" entitled to a free meal but ha+e been at some time in the last = "ears<
9 :
)*ou will need to apply for +ree School ,eals via South -los #.$ and return
a copy of the confirmation to the $cademy.
Food Allergies: , / 2
Dietar" 4e>uirements: , / 2
)f ?"es@ to either of the abo+e# please pro+ide further details:
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". ,edical Details
+amily Doctor and ,edical /istory
2ame of Doctor AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Practice/Address AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
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Phone 2umber AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
/as your child any medical conditions0issues &e.g. allergies' of which you
feel the
$cademy should be aware1 ,3S / 20
)f ,3S please gi+e details# including an" medication needed regularl":
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B
2. .thnic 3ac%ground4 /ome #anguage and eligion
5. 6ravel $rrangements
.thnic 3ac%ground (please stud" the list and tic. one bo- onl":
7hite( $sian or $sian 3ritish(
( British ( )ndian
( )rish ( Pa.istani
( !ra+eller of )rish Heritage ( Bangladeshi
( 1"ps" / 4oma ( /hinese
( An" other Asian Bac.ground
$ny Other 7hite 3ac%ground( 3lac% or 3lac% 3ritish(
( Albanian ( /aribbean
( BosnianCHerDigo+inan ( African
( /roatian ( An" 0ther Blac. Bac.ground
( 1ree. / 1ree. /"priot
( Eoso+an ,i8ed(
( Serbian
( !ur.ish / !ur.ish /"priot ( ;hite and Blac.
/aribbean
( ;hite 3astern 3uropean (including ( ;hite and Blac. African
4ussian# Lat+ian# Polish# Bulgarian# ( ;hite and Asian
/Dech# Slo+a.# Lithuanian# 4omanian# ( An" 0ther Mi-ed
Bac.ground
Montenegran
( ;hite ;estern 3uropean (including
)talian# French# 1erman# Spanish# ( An" 0ther 3thnic
Bac.ground
Portuguese and Scandana+ian ( ) do not *ith an ethnic
( An" 0ther ;hite Bac.ground bac.ground categor" to be
/ome #anguage(
!he list belo* contains some of the most commonl" used languages *ithin South
1loucestershire and the surrounding areas( Please select a language from the list
belo* to *hich "our child *as first e-posed in their earl" childhood and *hich
the" continue to use or be e-posed to at home or in "our communit"( )f "ou
cannot see the language on the list please gi+e details alongside ?0ther@(
( Pun$abi ( /hinese 0ther ( Lithuanian
( Polish ( ;elsh / /"mraeg ( Lat+ian
( Portuguese ( 3nglish ( 1ree.
( Arabic ( French ( 1u$urati
( Bengali ( 1erman ( Hindi
( /hinese /antonese ( !ur.ish ( )talian
( /hinese Ha..a ( F.ranian ( 4ussian
( /hinese ( Frdu (
Serbian//roatian/Bosnian
( Somali ( Spanish ( 0ther
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( Please indicate here if .nglish is an additional language for the student
eligion:
( Buddhist ( Ge*ish ( 0ther
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( /hristian ( Muslim ( 2o religion
( Hindu ( Si.h
=
#i%ely method of travel to and from 36.$ &please tic%'(
Bic"cle 9 :

;al. to B!3A 9 :
Academ" /oach 9 : ;hich route5 A 9 : B 9 : / 9 : D 9 : 3 9
:
/ar 9 :
Public !ransport 9 :
!a-i 9 :
9. Care4 Special .ducational :eeds and Disabilities
Care ;nformation (please tic. as appropriate(
( Loo.ed After /hild
( ,oung /arer
Special .ducational :eeds and Disability information(
Does "our child ha+e an" Special 3ducational 2eeds or Disabilities5
( 2o
( ,es
Please gi+e details:
( School Action ( School Action H
( Statement ( Disabilit"
)f "ou ha+e tic.ed an" of the abo+e# please gi+e details:
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<. Parental Permission
Permissions
) gi+e permission for (tic. all that appropriate:
( Student information other than name and address to be gi+en to /onne-ions
( M" child to ta.e part in lessons in+ol+ing se- education
( M" child to attend school +isits offCsite( ) understand that parents *ill be informed of
trips ahead of time
( M" child@s photograph and image on +ideo to be used b" the Academ" for
publication
for use in identification purposes# lessons# P4# ad+ertising and on the
Academ" *ebsite and blogs(
( M" child to access the internet +ia school computers and/or other school digital
e>uipment(
Signed: AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
Date: AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA
;f you are applying for a place in *ear 1=4 please go to Section
>
;f you are applying for a place in *ear 124 please go to Section
1=
:ow go to Section 11
I
>. Options ? *ear 1=
1=. Options ? *ear 12
7hich of the following sub@ect would you li%e to study alongside the core
sub@ects1
Core( Mathematics# 3nglish# Science# 3ngineering# P(3( !utorial# 3nglish
Literature# 3n+ironmental Science# )(/(!# Business /ommunications# 3nrichment
Options ? please *rite 1 and 2 ne-t to "our preferred options and ne-t to "our
reser+e option
Art J Design 9 : Histor" 9 :
1eograph" 9 : 1erman 9 :
Spanish 9 : Music 9 :
3lectronics 9 : Product Design 9 :
Prior attainment
Please indicate the le+els that "ou ha+e achie+ed:
AS2 levels Predicted AS! #evels Current AS!
#evels
3nglish AAAA 3nglish AAAA
3nglish AAAA
Maths AAAA Maths AAAA Maths
AAAA
7e have created multiple pathways for your studies at #evel !. .verybody
studies $B#evel ,aths and #evel ! .nvironmental Sustainability.
;f you choose to study Pathway $ you will need to select three options
and write them into the C$D row in the table below.
;f you choose Pathway 3 you will need to select two options.
Pathway C offers one option choice.
*ou can choose from(
3iology
Chemistry
Physics
Computer Science
+urther ,athematics
Product Design
A % 6 7 A Le+el Maths
L(7 3n+ironmental
Sustainabilit"
B % 6
Single
3ngineering
A Le+el Maths
L(7 3n+ironmental
Sustainabilit"
/ % Double 3ngineering A Le+el Maths
L(7 3n+ironmental
Sustainabilit"
D !riple 3ngineering A Le+el Maths
L(7 3n+ironmental
Sustainabilit"
'
Eualifications already achieved &AS "'
Sub$ect Kualification
3g( 1/S3#
B!3/
Date 1rade/le+el
$dditional Fualifications &eg #eadership4 Du%e of .dinburgh'
/ourse Kualification Date 1rade/le+el
Please indicate below if you have an interest in engineering and environmental
technologies(
*es :o
-CS. 0 36.C Predictions
&
Prior attainment
Please indicate the le+els that "ou ha+e achie+ed:
AS! #evels
3nglish AAAA
Maths AAAA
Science AAAA
7e will offer a resit course for those students who do not achieve a -rade C in
.nglish #anguage. Please discuss this when you meet with a representative
from the $cademy.
Eualifications currently being ta%en ? must include .nglish4 ,aths4 Science
&36.C4 Double $ward4 ;ndividual'4
Sub$ect Kualification
3g( 1/S3#
B!3/
A*arded
(eg summer
6L%6
1rade/le+el predicted
Please indicate below if you have an interest in engineering and environmental
technologies(
*es :o
:ow go to Section 11
%L
Please include a copy of your most recent school report and attendance from
*ear 9 up to the current year. 6his data should be available from your school.
( School 4eport included ( Attendance data included
Please sign and date below(
%%
1!. Signature
12. School eport 0 $ttendance
11. +urther ;nformation
Signed (Student: AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Date:
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Signed (Parent/1uardian: AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA Date:
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Gse the space below if you would li%e to provide any further information about
your
reasons for applying to the 36. $cademy(
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