SIXTH FORM APPLICATION 2014/2015

STUDENT DETAILS
Legal First Name: Legal Last Name: Address: Date Of Birth: Country Of Birth: Nationality: (Please Tick) Other: Resident in the UK for the last 3 years or more: YES Town: Email: Telephone: Mobile: Current School/College Attended: Postcode: Gender: Doctor: Surgery Contact No: MALE FEMALE NO UK EU EEA

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EQUAL OPPORTUNITIES MONITORING

The MFG Sixth Form is committed to equality of opportunity and welcomes applications from all learners irrespective of gender, sexuality, disability, race or religion. We are required to obtain data on the ethnic origin of our students - please tick one box which you feel best describes you. DUAL HERITAGE White & Asian White & Black BLACK OR BLACK BRITISH African Caribbean Other Black ASIAN OR ASIAN BRITISH Bangladeshi Indian Pakistani Other Asian WHITE British Irish Other White
Please tick if you speak English as a second language

OTHER Please specify:

QUALIFICATIONS
SUBJECT

(List all subjects you have been entered for this year and any already obtained)

COURSE TYPE

(e.g. GCSE / DIDA / BTEC)

TIER (higher/foundation)

PREDICTED GRADE

MOCK GRADE

English Language English Literature English Maths Science

GCSE GCSE GCSE GCSE VOC / DUAL / TRIPLE / BTEC

COURSES APPLIED FOR

SUBJECT LEVEL A Level (Level 3), Applied A Level (Level 3), BTEC (Level 3)

SIXTH FORM APPLICATION 2014/2015

CAREER IDEAS
Please indicate your current intentions after sixth form: Higher Education (e.g. university) Higher Apprentiships Employment Career Ambition (please state e.g. teacher, engineer, architect)

VOLUNTEERING / INTERESTS / HOBBIES

Briefly outline any volunteering, interests or hobbies you are involved in e.g. Sport Leaders, Youth Groups, Cadets, Charity or Duke of Edinburgh.

ADDITIONAL OUT OF SCHOOL COMMITMENTS (e.g. young carer, national sport trials)

REASONS FOR CHOOSING THE MFG SIXTH FORM

For my post-16 option The MFG Sixth From is my: 1st choice

2nd choice

3rd choice

ADDITIONAL SUPPORT
We are committed to meeting the needs of all of our students, so please let us know of any additional needs you may have. The information you provide will not affect your chances of being offered a place at The Mirfield Free Grammar Sixth Form. Please tick the relevant boxes.

I am living or have lived in residential care accommodation I am currently entitled to a free school meal I have a medical condition (please specify)

I have a Statement for Special Educational Needs (please specify) I have a learning difficulty and have received extra support in lessons I have received extra support in exams ( ) extra time reader scribe separate venue direct support at High School
You will be given the opportunity to discuss your needs fully at your admissions meeting, however you must declare any learning or medical difficulties on application in order to receive support/concessions in Sixth Form.

I have a medical condition which can impact on my learning e.g. Dyslexia, Dyscalculia, Aspergers, Dyspraxia, Autism, Diabetes or Epilepsy (please specify)

SIGNATURES
DATA PROTECTION ACT 1998
I agree to The Mirfield Free Grammar Sixth Form processing personal data contained in this form, or other data that the Sixth Form may obtain from me or other people whilst I am a student. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any other legitimate reason. I understand that information on me may be used for statistical analysis and also by the Careers Service.

Signature Of Applicant (please sign below)

Signature Of Parent / Carer

(please sign below)

Date:

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Date:

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Please note: Your application will be recorded on our database when you have submitted this form. This will ensure that you will have a one-to-one meeting with our admissions team. If relevant, your information will be viewed by our Learning Support team and if necessary, you will be contacted to discuss your additional support needs.

CONTACT Tel. 01924 483660 Fax. 01924 483661 Email. sixthform@themfg.co.uk www.themfg.co.uk/sixthform

RETURN ADDRESS
When the form is completed please return to:

RETURN BY
This form must be returned to the school no later than:

Sixth Form Admissions The Mirfield Free Grammar and Sixth Form Kitson Hill Road, Mirfield, West Yorkshire, WF14 9EZ

21st Feb 2014