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Aspiring Minds Application Form
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Student Personal Details
Forename
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Surname
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D.O.B
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Gender
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Male
Female
Nationality
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Email
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Telephone
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Mobile
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Address
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Emergency Contact Details
Title
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Mr
Mrs
Ms
Miss
Forename
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Surname
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Telephone
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Mobile
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Email
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Address
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Current Education Details
School Name
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Academic Year
Year 9
Year 10
Year 11
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English Predicted Grade
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A
B
C
D
E
Maths Predicted Grade
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A
B
C
D
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Science Predicted Grade
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A
B
C
D
E
English Target Grade
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A
B
C
D
E
Maths Target Grade
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A
B
C
D
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Science Target Grade
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A
B
C
D
E
Medical Details
Do you have any medical conditions that we should know about? E.g. Asthma, Diabetes etc.
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Are you on any prescribed medication?
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Do you have any special requirements? E.g. Special Education Needs etc.
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Payment Details
Please pick a payment structure:
Payment for One Full Year (£595)
Payment for One Term (£350)
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How did you hear about us?
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Anything else you would like to mention?
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