www.paddington-academy.

org

SIXTH FORM APPLICATION FORM

For courses starting in September 2016
Applications should be submitted as an email attachment to:
sixthform@paddington-academy.org
Name:
Date of birth:
Current school:

The closing date is 4 pm on Friday January 8th 2016

Applications will be considered as soon as they are received.
All applications received electronically before the deadline will be
acknowledged; applications received late may be considered but will not be
acknowledged.
office use only
Date Received:
Date reference
requested:
Date reference
received:

PLEASE COMPLETE IN BLOCK CAPITALS

Forenames
Please underline the name by which the student is usually known.

Surname
Date of Birth
Email
address:
Names of
brothers /
sisters already
at this school

Sex (M/F)

Or any other
relatives

Students
home
address
Postcode
Home Tel No

Student Mobile
No
Adults living at students home address

Relationship
pupil
Title

e.g. Mother

e.g. Father

Forenames
Surname
Work Tel No
Mobile No
Who should be the
primary contact for
the school? (please
tick one)
Are there any parents who dont live at
home but do have access?
If YES, please give details below in
other contacts

Yes/No

Looked After

Yes/No

Child

Other contacts
(Give names, daytime
telephone numbers &
relationship to student)

Name of
school
you are
currently
Name of
referee
Your referee should be
your head of year,
head teacher or form
tutor

Email
address of
referee
References are
required for all
students and will be
requested if
application is
shortlisted
Please list any other
schools you
have attended
in the last three
years and the
dates you were
on roll
(ie since Sept 2009;
please give
month and year
of joining and

Medical Details
Doctors name

Tel. No

Address

Existing medical conditions:

(Please note that any student who is found to have an existing medical condition not disclosed at
time of application will forfeit his/her place at the school)

Mother Tongue
What is your main home language?
Ethnicity
Approved Extended Categories
DfES Extended Codes
Please find appropriate categories and code from ethnic origin sheets provided

Religious Affiliation
State your religion (if any):

Free School Meals

Yes / No

Accommodation

Transport used to
school

Traveller

No. in family
under 16

Refugee/Asylum
Seeker

Perm/Temp
Yes / No
Yes / No

Do you have a Statement of Educational Needs? Yes/No

Have you had support for special needs? Yes/No
If so, please give details:
Do you qualify for special exam access arrangements? Yes/No
If so, please give details:
SEN Stage if known:
Have you been living in the UK for the last three consecutive
years? Yes/No
If no, state how long you have been living in the UK:
4

QUALIFICATIONS ALDREADY COMPLETED

Please attach scans or photocopies of all qualifications
Qualification
(eg GCSE, BTEC First
Certificate etc)

Subject

Grade

QUALIFICATIONS DUE TO BE COMPLETED BY AUGUST

2016
Qualification
(eg GCSE, BTEC First
Certificate etc)

Subject

UCI number:

This should appear on any results documents; if not, you can obtain it from your exams officer

SUBJECTS YOU WISH TO STUDY IN THE SIXTH FORM

Please circle or highlight the subjects you wish to take in the sixth form.

You need to choose subjects from four different blocks.

You may only choose one subject in each block.

AS Chemistry, AS Biology, AS English Literature and AS Psychology are available in two blocks;
students should select these subjects in one of the blocks only.

If you are choosing a BTEC Level 3 Diploma course you must select one Core A block and one
Core B block; students taking a BTEC Level 3 Extended Diploma must also select the course in
the option block.

If two or more of the subjects you wish to study are in the same block, please indicate this in the
space below; we will accommodate your selection if it is possible.

Biology
Business
Studies

Chemistry

C
English
Literature
Film Studies

History

Law

Maths (M)

Maths (S)

Physics

Music Tech
Philosophy

Psychology

Psychology

Health & Social

Care Core A
Media Core A
Business Core A

Health & Social

Care Option
Media Core B
Business Core B

A-level Maths (M and S)

Art

Arabic

Biology

Chemistry

Economics

Design

English
Literature
Spanish

Drama

AS

Economics
Geography
Sociology

GCSE English
Work Skills

Business Core A
Applied Science
Core A
GCSE Maths
GCSE English

Media Option
Business Option
Applied Science
Core B

Work Skills

Business Core B
Applied Science
Option
GCSE Maths
GCSE English
Work Skills

Level 2

GCSE Maths

Health & Social

Care Core B

BTEC 1st
Year

Sport

Subject combinations you would like to take but cant under the existing blocking
system (please give as much information as possible):

Please explain why you wish to apply for the courses you have
selected:

Please explain why you wish to join Paddington Academy Sixth

Form:

Please indicate how you feel you can contribute to Paddington

Academy Sixth Form:

DATA PROTECTION ACT

The information you provided will be used by your childs teacher and by the Education
Authority. Some of the information will be supplied as general statistical data to the
Location Education Authority and the Department of education and skill. All information
given will be treated confidentially and kept securely. All computerised data held on
pupils is covered by Data Protection Act.
I give consent for my son/daughter to provide biometric information in order to
purchase food in the school canteen
yes
no
I give consent for my son/daughters image to be used in photographs around school,
on the school website and in other promotional materials
yes

no

I give consent for my son/daughter to be taken off-site during the school day for
educational visits
yes

no

I declare the information on this form to be correct to the best of my

knowledge

Signed.......................................................
(Parent / Carer)

Date............................

Signed.......................................................
(Student)

Date............................

A signature is not required on electronic applications.