PARK HOUSE SCHOOL & SPORTS COLLEGE SIXTH FORM

APPLICATION FORM
Surname Male Female Forename(s) ..... Date of Birth Age on 1st September . Address .. Postcode.. Main phone ...Student Mobile.. Student Email (please write clearly) ... Present School .. School contact name and Email . Parent/Guardian Contacts Name .

1. Email (please write clearly) mobile ..

Address if different from above ... Name 2. Email (please write clearly) mobile .. Address if different from above .... ...........

MEDICAL INFORMATION Doctor: Address: Post Code: Ethnicity: (please tick) Any other Asian background Any other Black background Any other ethnic group Any other mixed group Any other white group Bangladeshi Black African Black Caribbean Chinese Gypsy/Roma Indian Pakistani Traveller with Irish Heritage White British White Irish White and Asian White and Black African White and Black Caribbean Refused Home language: please tick) Albanian Bengali British Sign Language Chinese Danish Dutch English Finnish Flemish French Gaelic Irish Gaelic Scottish German Greek Hebrew Hindu Italian Japanese Korean

Surgery Name: Telephone: Religion (please tick Buddist Christian Church of England Hindu Jehova Jewish Muslim No Religion Other Religion Roman Catholic Sikh

Kurdish Norwegian Other Polish Portuguese Punjabi Romany Russian Serbo-Croat Sinhala Somali Spanish Swahili Turkish Urdu Vietnamese

In order to support students through Years 10-13 careers guidance, Newbury Careers guidance, Newbury Careers Centre ask that we provide details from our database of students name, address, telephone number, date of birth, gender. It will be assumed that you have no objection to this information being passed on, unless we hear from you in writing. Signed: _____________________________________________ Date: ____________________________ Parent/Guardian All the information contained on this form is subject to the Data Protection Act.

On the next two pages you are asked to provide as much information as possible about yourself and what you wish to study. Park House Sixth Form offers an excellent range of courses and students benefit from a large variety of opportunities. In planning for your time in the sixth form the school needs information that enables resources to be used most effectively. Please try to help us ensure that you get the most out of your time at Park House by giving as much information as you can. Choosing the right subjects and courses is your first priority. If you would like to discuss possible choices with the Head of Sixth Form or visit the school please contact the school 01635 573911.

QUALIFICATIONS. Please list qualifications already held or being studied with predicted grades or actual grades for subjects already taken.
P Predicted Grade GCSE Eng Language Eng Literature Mathematics Grade P/A GCSE A Actual Grade Grade P/A Other Grade P/A

When choosing courses please remember that you are required to achieve 5 A* - C grades and at least a B in the subject you are studying (where appropriate).

Courses you wish to study. Mark each one D = Definite, L = Likely, P = Possible and a priority where 1 = highest
Subject/Course Reasons (Please do not leave blank) D/L/P Priority

Please explain any career plan-general direction-you have at present.

At the moment I am not sure what I would like to do once I have finished my education. I enjoy working closely with people and have taken into consideration a career in the NHS or as a Beauty Therapist.

FURTHER INFORMATION Please provide information about your interests, responsibilities and experience.

I enjoy the practical side of music, especially playing the piano, and I also like art, charcoal and pencil sketches in particular. My favourite subject is English, mainly poetry, I find it very interesting. I have been included in a number of school activities such as the School Chamber Concert, House Sports, House Dance, and the school Choir Concerts. As well as participating in these school activities, I have also been involved in many outside-school activities. I have gone through Rainbows, Brownies, Guides, and I had been put in charge of a team of girls to direct in many tasks while I was there. I have also helped out at a few local events, and have been a young leader in helping with a young Brownie Guide Unit. Before I joined Park House School in 2010, I attended a small home-school cooperative; once I reached 14 I helped the teacher with a variety of tasks such as answering some of questions from the younger students, helping them with parts of their work, and a couple other monitoring tasks.

Signed ______________________________ (Student) ______________________________ (Parent) Date ____________________________

For School Use Only Date received Date contacted Interview date Decision