A2 Direct Entry Application August 2016

Please complete all sections in black ink and CAPITAL LETTERS

HAVE YOU PREVIOUSLY APPLIED TO WOODHOUSE COLLEGE? YES NO

Your Name
Contact Details / Email / Mobile
Current Address
Home Tel / Post Code
Borough in which you live / Name of your last school
Date of birth / Gender: M or F / Age on entry to college on 31st Aug 2016

Ethnic origin: to help us with our Equal Opportunities monitoring please tick the most appropriate box.

ASIAN/ASIAN BRITISH / BLACK/BLACK BRITISH / OTHER ETHNIC GROUP / MIXED / WHITE
(39) Indian / (44) Black African / (47) Arab / (37) White/Asian / (31) English / Welsh / Scottish / Northern Irish / British
(40) Pakistani / (45) Black Caribbean / (98) Other / (36) White/Black African / (32) White Irish
(41) Bangladeshi / (46) Other Black / (35) White/Black Caribbean / (33) Gypsy or Irish Traveller
(42) Chinese / (38) Other Mixed / (34) White Other
(43) Other Asian

Residency Status

Excluding holidays, have you lived in the UK/EU since August 2013?
If ‘No’, when did you enter the UK/EU? ____/____/____ / Yes [ ] No [ ]

How We Use Your Personal Information

As part of the enrolment process, the college will take your photograph and use it to produce IDs and display on internal and external systems and documents to help with the teaching process and the normal life of the college.

Please tick here if you have any concerns about this and would like to discuss it further with a member of staff.

If you would like to be excluded from any of these aspects of sharing your data, you must put that request in writing to the Vice Principal for consideration.

Names & Addresses of Parent / Carer

Mr / Mrs / Other Title / Initials
Surname
Address
Telephone (home) / Telephone (work)
Mobile / Email
Relationship to student
e.g. Mother, Father etc

Student’s Signature: ………………………………………………………………… Date: ………………………………………

Continued overleaf…… PTO

OFFICE USE ONLY / Initials / Initials
Enrolled / Checked Contacts Details
Checked Personal & Contact Details / QoE Input/Check
UCI numbers / Acceptance paperwork emailed

SECTION 1: QUALIFICATIONS ON ENTRY

EXAMINATIONS: Please attach a copy of your GCSEs/IGCSEs and any AS results to this application form.

We need to know which AS subjects you are studying and the titles for each exam paper. (If applying to study A2 English Literature please list all the books you are currently studying on a separate sheet of paper).

AS Subject Title
(e.g. History) / Paper Reference Number and Title
(e.g. Unit 1 Option G, Britain 1815-1865) / Exam Board
(e.g. AQA)
Proposed A2 Subjects /

SECTION 2: GCSE / IGCSE QUALIFICATIONS

SUBJECT / Full GCSE
IGCSE
Short Course / GRADE / GCSE/ IGCSE SCORE / YEAR / Checked By
Woodhouse Staff (√)
Calculate your average score from FULL GCSE and IGCSE ONLY: / (Woodhouse Staff Name in full)
OTHER QUALIFICATIONS: e.g. OCR National, BTEC etc / GRADE / SCORE / YEAR / Checked By
Woodhouse Staff (√)
LEARNING DIFFICULTY / DISABILITY
Do you consider yourself to have a learning difficulty and / or disability?
Visual impairment / Hearing impairment / Profound complex disabilities / Other physical disability
Disability affecting mobility / Other medical condition / Other disability / Disability affecting mobility
Other physical disability / Temporary disability after illness (eg: post viral) or accident / Prefer not to say

Social & emotional difficulties / Mental health difficulties / Severe learning difficulty / Dyslexia
Dyscalculia / Autism spectrum disorder / Aspergers syndrome / Other specific learning difficulty (eg: Dyspraxia)
Moderate learning difficulty / Other learning difficulty