/ Year 9 Application Formfor September 2018
This form must be returned by31 January 2018to:
Year 9 Admissions, Elutec, Yew Tree Avenue, Rainham Road South,
Dagenham East, RM10 7FN or
CHILD’S DETAILS
Legal first name(s): / Gender:
Legal surname: / Date of birth: (dd/mm/yyyy)
1. Main home address
Line 1:
Line 2:
Town:
Postcode:
EDUCATION DETAILS
Current school: / Date:(mm/yyyy)
From:
To: / Local Authority:
ADDITIONAL INFORMATION
Special Educational Needs

Does your child have a Statement of Special Educational Needs or an Education andHealthcare Plan?

Yes / No

If yes, please provide details

Does your child have any other needs you feel we should know about?

Yes / No

If yes, please provide details

CHILD IN CARE

Is or was your child in the care of a local authority?

Yes / No

If yes, which local authority was responsible?

Name of social worker
Phone number:

Please also provide a letter from the social worker confirming the legal status of the child and name of the local authority the child is/was in the care of.

HOW DID YOU HEAR ABOUT US?
 / Word of mouth /  / Careers event /  / Newspaper /  / Careers services
 / From your current school /  / Website /  / Facebook /  / Rear of the bus
 / Other, please state
NON – UK APPLICANTS
Which country was the child born in?
Date of entry to the UK: (mm/yyyy)
Is the child in the country now? /  Yes /  No
Child’s first language:
Can the child speak, read and write fluent English? /  Yes /  No
PARENT/CARER DETAILS
Main contact / Address :
Title: (Mr/Mrs/Miss) / First name:
Relationship to child: / Surname:
Email:
Home telephone: / Mobile:
PARENTAL DECLARATION
  • I confirm that I am the person with parental responsibility for the child named in the application form.
  • I have fully read and understood your admission criteria and want to apply for a place at Elutec.
  • I believe the facts I state in this application to be true and accurate.
  • I understand that if I give false or deliberately misleading information on this form or supporting information this application will no longer be valid and you may withdraw the offer of a school place.

Signature of parent/carer / Date:

Elutec has a duty under the Children Act 2004 to work with partners to develop and improve services to children and young people in the area. As such, Elutecmay also use this information for other legitimate purposes and may share information (where necessary) with other external bodies responsible for administering services to children and young people. **Please note, year 9 admissions are subject to DfE approval which we are still waiting for. Indications from the DfE suggest that approval will be granted shortly.

Applicants whose forms are received by 15 January 2018 will be notified whether or not they have a place on 16 April 2018. Applications received after 16 January 2018will be considered as long as we still have places available.

Please return this application:

By post

Admissions

Elutec

Yew Tree Avenue

Dagenham East

RM10 7FN

Elutec Year 9 Application Form / Page 1 of 3