Matravers Sixth Form

Matravers Sixth Form

Application for September 2017

Name: ______

Present School: ______

PART A: PERSONAL INFORMATION

Surname:
First Name(s):
Date of Birth: / Gender:
Parent(s)/Guardian(s) Name and Initials:
Home Address:
Post Code:
Home Telephone No.: / Mobile No.:
Email Address:
*UPN / *UCI
*available from your current school

PART B: OPTION CHOICES

Please state which subjects you wish to study. You should choose 3 subjects from Option Blocks A – E. You may add reserve choices if you wish.

A / B / C / D / E
Preference
Reserve Option

All courses are provisional and based upon suitability, demand and timetabling restrictions.

Please list any other subjects that you may be interested in studying:

Please explain briefly why you wish to undertake the courses for which you have applied:

Student’s signature: ______Date: ______

Parent’s/Guardian's signature: ______Date: ______

PART C: ACADEMIC INFORMATION

Please list the subjects you are studying, then give this application form to your Tutor who will fill in your estimated grades and complete the final section. The final two columns in the grid below will be completed by the member of staff who interviews you, so you only need to complete the first three columns.

Subjects / Level
(e.g. GCSE/
BTEC) / Estimated Grade / Grades Achieved / Date Achieved
English Language
English Literature
Mathematics
Science
Yes: / No:

PART D: SUPPORT

Have you received support either at school or elsewhere?

If ‘yes’, tick which of the following:

Extra classes / Extra time in exams
Help in class from a Teaching Assistant / Separate room for exams
Case Worker / Reader or scribe for exams
Other Support Worker / Use of word processor in exams
Other – Please Specify

PART E: RESPONSIBILITIES/INTERESTS

Please list the roles and responsibilities you have held at school (including when you may have represented the school):

Please list the activities/interests you have, both in and out of school:

ENRICHMENT IN SIXTH FORM

Please indicate which of the following additional activities interest you:

Academic Writing / Combined Cadet Force / Fitness / Sports Clubs / Teams
Arts Award / Cooking / Languages / Sports Leaders
Careers / Current Affairs / Mentoring Younger Students / Ten Tors
Charities / Duke of Edinburgh / Senior Student Team / Young Enterprise

PART F: FUTURE PLANS

Yes: / No:

Do you wish to progress to University?

What career possibilities have you considered?

Please return this form to the Director of Post-16:

Mr Ian Browning, Matravers School, Springfield Road, Westbury, Wiltshire, BA13 3QH