West Lakes Academy Sixth Form Application Form for September 2018 Enrolment

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Email *

Name of Previous School *

PUPIL DETAILS

Legal Surname *

Legal Forename(s) *

Chosen Name *

Date of Birth *

Gender

Male

Female

Clear selection

Home Telephone Number *

Mobile Telephone Number *

House Number *

House Name *

Street *

District *

Town *

County *

Postcode *

CONTACT DETAILS

Please give details of all persons who have parental responsibility as well as details of anyone else you wish to be contacted in an emergency.
The mobile telephone number and email of the Priority 1 contact will be used in the event of absence and for other important information. The email address will also be used as our preferred method of communication which includes sharing student reports. If you do not have mobile number or e-mail address then we will contact via landline number or via letter.

PRIORITY 1 CONTACT - PARENT/CARER

Title *

Mrs

Surname *

Forename *

Relationship to pupil *

Parental Responsibility for pupil *

Yes

Home Telephone Number *

Mobile Telephone Number *

E-mail Address *

Home Address *

Home Postcode *

Work Place *

Work Telephone Number *

PRIORITY 2 CONTACT - PARENT/CARER

Title *

Mrs

Surname *

Forename *

Relationship to pupil *

Parental Responsibility for pupil *

Yes

Home Telephone Number *

Mobile Telephone Number *

E-mail Address *

Home Address *

Home Postcode *

Work Place *

Work Telephone Number *

ADDITIONAL EMERGENCY CONTACTS

Title *

Mrs

Surname *

Forename *

Relationship to pupil *

Home Telephone Number *

Mobile Telephone Number *

SIBLINGS ATTENDING WEST LAKES ACADEMY

If there are any other children living at the above address who currently attend West Lakes Academy please list them below stating full name and tutor group.

Sibling name(s) and tutor group(s) *

MEDICAL DETAILS

Medical Practice *

Telephone Number *

Address *

Medical Condition(s) *

I GRANT/DO NOT GRANT (please choose as applicable) the Academy permission to administer Paracetamol for general pain relief *

I GRANT

I DO NOT GRANT

I GRANT/DO NOT GRANT (please choose as applicable) the Academy permission to administer Salbutamol in an asthma emergency. *

I GRANT

I DO NOT GRANT

NOT APPLICABLE

ADDITIONAL INFORMATION

Meal Arrangements *

Free Meal

Sandwiches

School Meal

Travel Arrangements *

Ethnicity *

Religion *

First Langauge *

Home Language *

Country of Birth *

Nationality *

Please list the routes you are considering for your post 16 education in order of preference (e.g. WLA, College, GEN2) *

Sixth Form Option Choices

Please select your options from each column (max 4)

Column A *

Column B *

Column C *

Column D *

Column E *

Column G (Further options) *

Please list your fourth choice subject (least preferential) *

Please select which pathway you intend to follow. (If there are subjects in more than one pathway please select the one that best fits). *

Challenge

Academic

Blended

Specialist

Why would you like to attend WLA sixth form and why have you selected the options above? *

What are your future plans after you have completed sixth? Please specify a university course/job or apprenticeship route if known *

What is your proudest achievement and why? *

For Information:

We will be interviewing every applicant for WLA Sixth Form and will contact you shortly to schedule an interview. Interviews will be held over the upcoming weeks between 9am and 6pm Monday to Friday.

As well as keeping you informed via text we will also publish key information on our website http://www.westlakesacademy.org.uk/ and on our twitter feed @WLASixthform.

If you have any further questions or would like guidance completing this form please contact us on 01946 820356 or e-mail us at simpsonbk@westlakesacademy.org.uk

If you are applying from another school please print and complete the predicted results and school reference form in preparation for your interview. You can either bring it with you or email/post it to us:

Please indicate if your parent/guardian will be attending your sixth form interview below *

Yes

Data Protection Act 1998:

The academy is registered under the Data Protection Act for holding personal data. The academy has a duty to protect this information and to keep it up to date. The academy is required to share some of the data with the Local Authority, the DfES and Youth Support Services. The current version of the academy’s Data Protection policy is available on the website at www.westlakesacademy.org.uk Paper copies are also available on request.

A copy of your responses will be emailed to the address you provided.

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