Personal Details

Name *

First

Last

Date of Birth

Age on 31 August 2019:

Gender

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Telephone (Day)

Telephone (Evening)

Mobile Phone

Email *

Nationality

Country of Birth

Have you lived outside the UK during the last 3 years?

Yes
No

If YES, what was your country of residence?

Date of entry into the UK:

Course Selection

Please list the three subjects you have chosen in priority order, with an additional selection as a possible reserve.

1

2

3

4

(Four A Level Pathway only)

Reserve Choice:

Please be aware that these are proposed courses and may be subject to change.

Education

What school did you last attend/are you currently attending?

School

School Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Date Attended From

Date Attended To

Learning Support

Do you consider that you have a disability/learning difficulty or other need you wish us to know about?

Yes
No

(If yes, we want to help you get the best from your courses and will arrange for a member of our Learning Support team to discuss this with you in confidence.)

Additional Languages

If you speak more than one language at home and would like to meet with our MFL Department to discuss potential qualifications in additional languages as part of our Polyglot Programme, please complete the information below:

Checkboxes

I am interested in the Polyglots Programme and would like further information

Languages Spoken

Signature Section

The information on this form will be used for administration purposes by the school; because of the Data Protection Act 2018, the school requires your consent before it can be used. Applicant information may be disclosed to Career Connect and other agencies for statistical reasons. Data is carefully controlled by the school’s Data Protection Policy, which is available on request. We ask you to confirm, by signing below, that the information contained is accurate and that you consent to Formby High School using the data for its legitimate purposes.

Applicants Signature

Type your name here to confirm that you have read and understand that the information contained is accurate and that you consent to Formby High School using the data for its legitimate purposes.

Date