QUEEN ELIZABETH’S SCHOOL

SUPPLEMENTARY APPLICATION FORM FOR ADMISSION

SEPTEMBER 2011
PLEASE COMPLETE THIS FORM AND RETURN TO THE SCHOOL AS SOON AS POSSIBLE AND NO LATER THAN NOON ON 22ND OCTOBER 2010.
PLEASE SELECT ONE OF THE FOLLOWING TO INDICATE HOW YOU WISH YOUR SON’S ABILITY TO BE ASSESSED. PLEASE NOTE THAT THE 20 PLACES FOR MUSIC
ARE AVAILABLE ONLY TO THOSE WHO SIT THE SECOND ENTRANCE TEST AND WHO HOLD A GRADED TEST CERTIFICATE AT GRADE 3 LEVEL OR ABOVE.
ENTRANCE TEST:  ENTRANCE TEST AND MUSIC AUDITION: 

BOY’S FIRST NAME: PPLLEEAASSEE

SSTTA
APPLLEE YYO OUUR
R
SSO N ’
ON’SS
BOY’S LAST NAME: PPHHOTOG
O TO GRRAAPPH
H
H ER
HERE E
BOY’S DATE OF BIRTH:

PARENT OR GUARDIAN DETAILS

FULL NAME OF PARENT OR GUARDIAN:

DETAILS OF GUARDIANSHIP IF PARENT IS

NOT SIGNNG THIS FORM:
FULL POSTAL ADDRESS:

POST CODE:

TELEPHONE NO (DAY): TELEPHONE NO(EVENING): MOBILE TELEPHONE NO: YOUR LOCAL AUTHORITY:

CURRENT SCHOOL
DETAILS OF CURRENT SCHOOL: ENTRY DATE: LEAVING DATE:
SCHOOL NAME, ADDRESS AND TELEPHONE NO:

A primary school would be contacted in the event that we felt we needed to seek advice about a child’s
special educational needs, medical condition or disability. Such information will enable us to ensure that
no child is disadvantaged when he comes to sit our entrance tests. We might also contact a primary
school should there be an emergency when your son is at Queen Elizabeth’s sitting an entrance test.

ADDITIONAL INFORMATION
Please use the reverse side of this form to give further details if the answer to any of these questions is YES:
DOES YOUR SON HAVE A MEDICAL CONDITION WE SHOULD TAKE INTO ACCOUNT WHEN
PROCESSING YOUR APPLICATION?
YES  NO 
HAS YOUR SON BEEN THE SUBJECT OF ANY SEN ASSESSMENT? YES  NO 
DOES YOUR SON HAVE A DISABILITY? YES  NO 

1
ADDITIONAL INFORMATION
These details MUST be supplied by those parents who wish their son to be auditioned to assess ability in music.
INSTRUMENT PLAYED (INCLUDING PIANO): MOST RECENT MOST RECENT COPY
GRADE MARK CERTIFICATE
ATTACHED


THEORY

THIS SPACE HAS BEEN LEFT AVAILABLE FOR YOU TO USE IF YOU WISH TO PROVIDE US WITH INFORMATION REGARDING A DISABILITY OR
MEDICAL CONDITION OR SPECIAL EDUCATIONAL NEEDS.

All Parents or Guardians are requested to read the following before signing.

I hereby confirm that the information I have provided is accurate.

SIGNATURE OF PARENT/GUARDIAN:

DATE:

BEFORE SUBMITTING YOUR SUPPLEMENTARY APPLICATION FORM, PLEASE ENSURE THAT THE FOLLOWING
ARE ENCLOSED:
ONE SELF ADDRESSED ENVELOPE IF YOU WOULD LIKE US
COPY OF GRADED MUSIC CERTIFICATES, IF
TO CONFIRM WE HAVE RECEIVED THIS FORM SAFELY  APPLICABLE

(NORMAL LETTER SIZE)
PLEASE COMPLETE AND RETURN THIS FORM TO THE SCHOOL AS SOON AS POSSIBLE
AND NO LATER THAN NOON ON 22ND OCTOBER 2010.

PLEASE ALSO ENSURE THAT YOUR COMMON APPLICATION FORM NAMING QUEEN ELIZABETH’S IS RETURNED
TO YOUR LOCAL AUTHORITY BY THE PUBLISHED DEADLINE.