DIOCESE OF JAMAICA & THE CAYMAN ISLANDS

THE QUEEN’S SCHOOL

LOWER SIXTH FORM APPLICATION 20117/18

INSTRUCTIONS: Complete this form in BLOCK CAPITALS. This form is

to be submitted along with two (2) passport-sized

photographs, a copy of your CSEC results.

PERSONAL INFORMATION:

Last Name / First Name / Middle Name(s)

Date of Birth: _____ / _____ / ______Gender: [ ] Male[ ] Female

DD MM YYYY

Place of Birth: ______Nationality: ______

Home Address: ______

______

Mailing Address (if different from above): ______

______

Telephone numbers: (Home) ______(Mobile) ______

E-mail Address: ______

CONTACT OF PARENT/GUARDIAN#1: (A parent or guardian with whom the student resides)

Name: ______Relationship: ______

Occupation: ______Email address: ______

Tel.: (Home) ______(Work) ______(Mobile) ______

CONTACT OF PARENT/GUARDIAN #2:

Name: ______Relationship: ______

Address: ______

Occupation: ______Email address: ______

Tel.: (Home) ______(Work) ______(Mobile) ______

RELIGIOUS AFFILIATION:

What is your religion/denomination/church? ______

Does your religion/denomination/church prevent participation in any activities? Yes ( )No ( )

If you have answered YES, explain:______

PREVIOUS SCHOOLS ATTENDED (List the most recent school attended first):

Name of Schools / Period Attended / Reason for Leaving
From / To
1.
2.
3.

CSEC Reg. No. ______Year of Entry: ______

Positions of responsibility held at most recent school: ______

______

List your involvement in Clubs & Societies: ______

______

Involvement in sporting activities: ______

REFERENCES

a)Name of Referee: ______Organization: ______

Position: ______

Address:______

______

______

Tel.: ______

b)Name of Referee: ______Organization: ______

Position: ______

Address:______

______

______

Tel.: ______

PERSONAL STATEMENT

Why do you want to attend The Queen’s School Sixth Form?(To be completed by the applicant)

______

How do you intend to contribute positively to the school community as a Sixth Form student? ______

SUBJECT SELECTION

List your CSEC results in the table below:

SUBJECT / GRADE / YEAR
English A
Mathematics

Using the qualification information given in the table below, applicants are required to select Communication Studies and three (3) other subjects in the pools given below the qualifications table. ONE SUBJECT MUST BE SELECTED IN EACH POOL.

SUBJECTS / CSEC QUALIFICATIONS
Accounting / Grade I or II in Principles of Accounts and Grade I or II in Mathematics
Biology / Grade I or II in Biology along with Grade I or II in Chemistry & Math
Chemistry / Grade I or II in Chemistry along with Grade I or II in Mathematics
Communication Studies / Grade I or II in English A
Economics / Grade I or II Mathematics & English A
Geography / Grade I or II in Geography
History / Grade I or II in Caribbean History
Information Technology / Grade I or II in Information Technology, English A and Mathematics
Literatures in English / Grade I or II in English A and English B
Management of Business / Grade I or II in POB, POA, Mathematics and English A
Mathematics / Grade 1 in Mathematics and Grade I, II or III in Additional Mathematics
Physics / Grade I or II in Physics along with Grade I or II in Mathematics
Sociology / Grade I or II in Social Studies, Caribbean History or Geography
POOL 1
Biology
Sociology
Accounts
Management of Business
Communication Studies
POOL 2
Chemistry
Accounts
Sociology
Literatures in English
Management of Business
Communication Studies
POOL3
Mathematics
History
Literatures in English
Geography
Management of Business
Tourism Management
Communication Studies
POOL 4
Physics
Information Technology
Law
Economics
Food and Nutrition
Communication Studies

First Career Choice:______

Second Career Choice:______

DECLARATION:

(a) I declare that the information given on this Admission Form is accurate and true. I commit to ensuring that my child/ward complies with the rules and regulations which govern students of The Queen’s School.

(b)I pledgeto provide the necessary financial and otherforms of support necessary to assist my child/ward as a student of The Queen’s School.

Name of Parent/Guardian: ______

Signature of Parent/Guardian: ______Date: _____ / _____ / ______DD MM YYYY

Signature of Applicant: ______Date: _____ / _____ / ______DD MM YYYY

FOR OFFICE USE ONLY

Interviewed by: ______Date: _____ / _____ / ______

DD MM YYYY

Year Group Coordinator’s Recommendation:______

______

APPROVED / NOT APPROVED / PENDING

Year Group Coordinator’s Signature: ______Date:_____ / _____ / ______

DD MM YYYY

Principal’s Comments:______

______

Approved by Principal: ______Date: ______

Identification #:______

Form assigned: ______

House assigned:______