BLUE COAT CHURCH OF ENGLAND SCHOOL AND MUSIC COLLEGE

APPLICATION FOR ADMISSION TO SIXTH FORM – SEPTEMBER 2015

Please return this completed form to Mr Miller, Head of Sixth Form, Blue Coat Church of England School and Music College, Terry Road, Coventry, CV1 2BA. E-mail:

Name: ______D.O.B. ______

Address: ______

______Post Code: ______

Tel No: (Home)______Student Mobile ______Name of current School: ______

Student email address______(Tutor Group if Blue Coat)______

Please indicate below the subjects presently studied and the predicted grade:

Subjects studied / Level / Grade / Subjects studied / Level / Grade / Subjects studied / Level / Grade

Present interests and activities

e.g. responsibilities, sports, hobbies, part-time work

Future Plans

e.g. career plans, including further education and employment

AS Levels Subjects Offered

Choose 1 AS subject from each block, you are expected to choose 4but in exceptional circumstances 5, OR choose 1 BTEC National Diploma. Please circle or highlight your choices.

BLOCK A
Mon am/Thurs pm / BLOCK B
Mon pm/Thurs am / BLOCK C
Tues pm/Fri am / BLOCK D
Wed am/Fri pm
Biology
Computing
Dance
English Language/Literature
French
Geography
Health and Social Care
Photography / German
Mathematics
Media Studies
Photography
Physics
Psychology
Religious Studies / Biology
Business Studies
English Literature
History
Mathematics
Music Technology
Psychology / Art
Chemistry
Economics
English Language/Literature
Music
Physical Education
Physics
BLOCK E
Tues am/Wed pm / BTEC NATIONAL
DIPLOMAS
Chemistry
Further Mathematics*
History
Product Design (3D)
Sociology
Theatre Studies (Drama) / ICT
Media Studies
Sports Studies
Football Academy

* If choosing Further Mathematics you must also choose Mathematics in Block B

BTEC National Diplomas are equivalent to 3 A Levels and universities accept them without additional qualifications.

If you have made choices which are a compromise because of blocking clashes, please indicate your preferred subject choices here:-

1. ______2. ______3. ______4. ______

Other courses available if there is sufficient interest: (Tick if interested)

Young Enterprise Extended Project

In order to receive the correct curriculum support and exam considerations please indicate if you have had:-

Learning Support

Exam Access Arrangements

Ethnicity (please tick one category) / Religion (please tick one category)
Any other Asian background / Buddhist
Any other Black background / Christian
Any other ethnic group / Hindu
Any other mixed background / Jewish
Any other White background / Muslim
Bangladeshi / No Religion
Black African / Other Religion
Black Caribbean / Refused
Chinese / Sikh
Gypsy/Roma
Indian
Pakistani
Traveller of Irish Heritage
White British
White Irish
White and Asian
White and Irish
White and Black African
White and Black Caribbean

Please give below ALL language (s) spoken at home

PLEASE NOTE COURSES CAN ONLY RUN WITH VIABLE NUMBERS

Signature of Applicant: ______

Signature of Parent / Guardian: ______Date: ______