Wellacre 6th Form Application

SECTION 1 - Student Details
Surname:		Forename(s):
D.O.B. (dd/mm/yyyy)
Email:
Address:
Post Code:
Home Telephone:		Mobile Number:

SECTION 2 - Course Choices
Type of course (e.g. AS/AGCE/Level 2 diploma/GCSE)	Subject(s) - type more than one in each box if need be.

SECTION 3 - Present School Details
Name of school
Address:
Post Code:

SECTION 4 - School Results/Predictions
Course Level (GCSE/GNVQ etc.)	Subject(s)	Predicted Grade

SECTION 5 - School Referee
Name
Position
Contact Number
Email Address

6. Disability Discrimination Act 1995

Do you have a disability or learning difficulty?

Yes

If yes, we want to help you get the best from your course.
How would you wish to let us know what you are likely to need?

Not applicable

By talking confidentially to a member of staff at Interview

By talking confidentially to a member of staff by Telephone

By talking confidentially to a member of staff in Writing

Through someone else such as an advocate, parent or carer, who will accompany you to your interview

7. Data Protection Act

Information you provide on this application form will be stored and processed and, because of the Data protection Act 1998, we need your permission before we can do this. Please check the box below as this will allow the College processing information about you.

I Agree to Wellacre Sixth Form College storing and processing data contained on this form.

If you do not agree we cannot process your application.