Application Form Closing date for applications is 4.00pm on Friday 27 January 2017

Transcription

1 THE BEST THAT I CAN BE Application Form Closing date for applications is 4.00pm on Friday 27 January 2017 Please complete using BLACK or BLUE ink and return to the: Sixth Form Admissions Secretary, West Hatch High School, High Road, Chigwell Essex IG7 5BT Late applications will join a waiting list and we cannot guarantee entry. Please complete all sections of the form and ask your current school to record attendance and punctuality endorsed by the school stamp on the page 4 before returning Are you are a current West Hatch student? Yes / No if yes then please proceed to section 1 UCI Number UPN Number ULN Number (Please ask the Exams Officer of your current school for these numbers) Are either parent in the Armed Forces: Yes Section 1: Personal Details / No Family Name: First Name: Middle Name: Date of Birth: / / Gender: Male Female Address: Post Code: Student Mobile Home Tel. No: (Compulsory THIS MUST BE THE STUDENT S OWN PERSONAL MOBILE NUMBER) Student (Compulsory THIS MUST BE THE STUDENT S OWN PERSONAL ADDRESS AND NOT THEIR CURRENT SCHOOL ) Section 2: Emergency Contact Details CONTACT 1: Provide full details of parent/carer where the student lives: Relationship to Student... Mr Mrs Ms Initials: Surname: Address: Postcode: Home Tel: Mobile: Work Tel:

2 Name of Local Authority to which you pay your Council Tax (please delete as appropriate) Essex / Redbridge / Other Please State CONTACT 2: Full details of any other parent/carer: Relationship to Student. Mr Mrs Ms Initials: Surname: Address: Postcode: Home Tel: Mobile: Work Tel: OTHER EMERGENCY CONTACT: Relationship to Student Mr Mrs Ms Initials: Surname: Home Tel: Full Name of Siblings already attending West Hatch (all students to complete). Section 3: Lunch Are you currently in receipt of free school meals: Yes / No If Yes, you may be eligible for a bursary award Section 4: Health Information Doctor s Name & Surgery: Address: Tel. No: Health please tick any that apply None Epilepsy Asthma Diabetes Sickle Cell Allergies

3 Section 5: Ethnicity and Religion What is your ethnic group? Please tick the box that best describes your ethnic group White Black or Black British Chinese British Caribbean Hong Kong Chinese Irish Angolan Other Chinese Traveller of Irish Heritage Congolese Gypsy/Roma Ghanaian Any other ethnic background Albanian Nigerian Afghanistan Italian Sierra Leonean Filipino Kosovan Somali Thai Greek/Greek Cypriot Sudanese Vietnamese Turkish/Turkish Cypriot Other Black African Any other ethnic group - Please state: White Eastern European Any other Black background.. White Western European White other Asian or Asian British I do not wish to disclose my ethnicity Mix/dual background Indian White and Black Caribbean Pakistani White and Black African Bangladeshi White and Asian Nepali White and any other ethnic group African Asian Other mixed background Other Asian Religion: Section 6: Nationality and Residency What is your Nationality? Where were you born?.... Have you lived in the UK for the last 3 years prior to the start of the course? Yes No If No, which country did you live in?. When did you arrive in the UK? / / (dd/mm/yyyy) Do you have? - Please tick as many boxes that apply to you, and give the dates as requested British Citizenship or a Certificate of Entitlement to the Right of Abode in the UK Indefinite leave to Enter/Remain Full Refugee Status Humanitarian Protection Discretionary Leave Expiry Date: / / A Family Reunion visa as the Child of someone granted Refugee Status: / / Asylum Seeker status If you are an asylum seeker, has your claim been with the Home Office for more than 6 months? Yes No A valid UK Visa, please which you have: Student Visitor Visa Number: Expiry Date: / / An EEA (European Economic Area) Residence Permit Right to Permanent Residence Are you? An EEA (European Economic Area) inc UK national or is a Family member an EEA inc UK national When did you start to live in the EU/EEA? / / The child of a Turkish Worker The child of a Swiss National

4 Section 7: Travel Section 2: Emergency Contact Details How will you travel to West Hatch School: Walking Car Contract Bus Public Transport Bicycle For queries regarding assistance with travel, please contact Essex County Council: Section 8: Support for your Learning We aim to create an inclusive and supportive environment, where you can feel safe and confident. Please help us to understand your needs by completing the sections below. This information is treated sensitively and will help us support your identified needs. Safeguarding please tick all that apply (you can tick more than one box) Are you a Looked-After child? 1 Yes No (This means a child who is in care of a Local Authority, Adopted, subject to a Residence order or subject to a Special Guardianship order) Are you and currently: Living with parent, guardian or family member Not living with a parent, guardian or family member Just left care In receipt of Income or ESA Living in a hostel or homeless Alone in this country None of the above Are you 19+ and currently: Have a support worker Have a social worker Have a psychiatric social worker Have a mental health support None of the above Section 9: Special Educational Needs Do you consider yourself to have any Special Educational Needs or Disabilities? Yes No If Yes: Please tick all that apply (you can tick more than one box) Moderate learning difficulty (e.g. statement from school) Severe learning difficult (e.g. statement from school) Dyslexia Dyscalculia Visual Impairment Hearing Impairment Hearing Aid User Disability affecting mobility Wheelchair user Other physical disability.. Other. Other specific learning difficulty Autism spectrum disorder Multiple learning difficulties (more than one) Other, please specify Emotional/behaviour difficulties Mental health difficulty Profound complex difficulties Asperger s Syndrome Multiple difficulties Temporary Disability after illness or accident. Have you previously had any special exam arrangements e.g. extra time and/or a reader? Yes No Are you currently in receipt of a Learning Difficulty Assessment (LDA) or Education Health and Care (EHC) Plan? Yes No Do you have a Caf or e-caf? Yes No The language spoken at home: Parents first language:.... Languages spoken by student: 1 A looked after child as defined by Section 22(1) of the Children Act 1989, is a child who is (a) in the care of a local authority, or (b) being provided with accommodation by a local authority. Priority is also given under this criterion for looked after children who ceased to be so because they: (1) were adopted under Section 46 for the Adoption and Children Act 2002; (ii) became subject to a residence order under Section 8 of the Children Act (1989), which settles the arrangements to be made as to the person with whom a child is to live; (iii) became subject to a special guardianship order under Section 14A of the Children Act 1989, which is an order appointing one or more individuals to be a child s special guardian(s). Applications under (i) to (iii) as outlined above, can only be considered if supporting documents, in the form of a copy of the adoption order, residence order or special guardianship order, together with a letter from the local authority that last looked after the child confirming that (s)he was looked after immediately prior to the order being made, is submitted with the SIF.

5 Section 10: Secondary Education Name of Current School (non-west Hatch Students only). School Address:.... Post Code:. Main Tel No: Main School Dates Attended: to (yyyy/yyyy) Name of Referee: Mr Mrs Ms Surname: This is the person responsible for producing predicted grades at your school. This is usually the Head of Year Referee Qualifications and Grades Subject/Course Exam Type Predicted Grade Actual Grade (if known) (Evidence to be provided with application form) To be completed by your current school Attendance (%) Punctuality (%) We confirm that the predicted grades above listed by the student are consistent with current school predictions Name of certifying member of staff School stamp

6 Section 11: Programmes of Study Please see the different Academic Pathways offered in the prospectus for more detailed information about subject choices. You will have at least 5 A*-C GCSE s including English and Maths, with B grades at GCSE in your relevant subject choices and/or meet any additional entry criteria for individual subjects listed in the prospectus for the A Level pathway A LEVELS: Please circle your THREE or FOUR choices from DIFFERENT COLUMNS in the diagram below having studied the West Hatch Sixth Form prospectus carefully. P Q R S T Art Biology Chemistry Chemistry Biology Business Studies Business Studies Geography Economics BTEC Dance Law Drama & Theatre Studies English Language/Literature Maths Core Maths English Language/Literature History Product Design English Literature French Law Cambridge Tech ICT Psychology Media Studies Media Studies Physics Spanish Sociology Philosophy & Ethics Physical Education BTEC Business Psychology BTEC Sport Sociology Extended Project Extended Project Extended Project Extended Project Extended Project GCSE Resit Maths/English GCSE Resit Maths/English GCSE Resit Maths/English Please research your choices carefully as any eventual offer will be based on the subjects you have chosen and you must meet the terms of this offer. If you wish to change your A Level choices after 27th January or following results in August 2017, we cannot guarantee that we will be able to accommodate your changes. VOCATIONAL PATHWAY LEVEL 3 - Office use only: Subjects offered: BTEC Level 3: Business Level 3: Childcare (CACHE) These are discrete full time programmes and cannot be taken with any other subject

7 Section 12: Additional Information Is West Hatch your first choice? Yes No If No, please state your preferred choice:. How did you hear about the Sixth Form? Please tick all that apply (you can tick more than one box) Banner outside School gate School Careers Adviser Current Student Former Student Friend or Family School Website Local Paper: Guardian Local Paper: Recorder South East Times Yellow Advertiser Word of Mouth Other (please give details).. How useful were the following in finding out more information about us? Very useful Quite useful OK Not very useful Not useful I did not use/see/attend Prospectus School Website Sixth Form Open Evening Advertisement Newspaper Article (Hatching Out) Section 13: Admission Criteria (please see full Admissions Policy at We offer a variety of different pathways to progress Post-16. Please make sure you fulfil the entry criteria for your choice of either Advanced Level Pathway, Combined Pathway, Vocational Pathway Level 3 before applying. These can be found in the West Hatch Prospectus. Each Post-16 course has its own entry criteria. Consequently, to gain admission on so the Sixth Form, all applicants, whether internal or external, will be required to meet the specific entry requirements for each course they seek to take as outlined in the admission prospectus. Section 14: Parental Consent Data Protection Act 1998: The school is registered under the Data Protection Act for holding personal data. The school has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and with the DfE. Please tick boxes below to confirm your consent for the following: Copyright permission Internet & wifi access Photographs Sex education Data exchange School visits

8 Section 15: Youth Support Agreement Admissions Policy at 13: Admission Criteria (please see full Admissions Policy westhatch.essex.sch.uk) PROVIDING OF INFORMATION TO PROVIDERS OF YOUTH SUPPORT SERVICES AND THE RIGHT TO OPT OUT Once your child is aged 13 or over, we are required by law to pass on certain information to providers of youth support services in your area. This is the local authority support service for young people aged 13 to 19 in England. We must provide both the child s and parent s name(s) and address, and any further information relevant to the support services role. However, if the child is over 16, the child (or the parent(s)) can ask that no information beyond names, address and your date of birth be passed to the support service. Please see below on how to opt-out of this arrangement. For more information about young peoples services, please go to the Directgov Young People page at or the LA website shown above. The School will not give information about you to anyone outside of the school without your consent unless the law and rules allow us to. The School is required by law to pass some information about you to the Local Authority and the Department for Education (DfE) To Opt Out If you wish to opt-out of this arrangement then please tick here. Alternatively you can contact the school admin team by ing admin@westhatch.essex.sch.uk or telephoning Section 16: Declaration If accepted, we agree to comply fully with the School s rules and regulations that will be issued at the same time as confirmation of offer. Student signature... Date. Parent/Carer Signature.. Date..