Please complete in block capitals using a ballpoint pen.

Section1

Surname / Forename (s) / Title / DOB (dd/mm/yyyy)
Home Address / Age (on 31st Aug 2017)
Postcode / Home Telephone
Mobile (Student) / Mobile (Parent)
Email (Student) / Email (Parent)
Current School / Unique Learner Number (ULN)

Section 2

Please choose one provisional option from each of the 5 columns

(Options are subject to change, including new subjects on offer.)

Option 1 / Option 2 / Option 3 / Option 4 / Option 5
Maths A Level / Core Maths / Core Maths / Further Maths / Maths A Level
Product Design / Design Engineering (double) / Business Studies / Design Engineering (Double) / Chemistry
Level 2 Engineering (Single) / Physics / Engineering (Single) / Health & Social Care (Double) / Computer Science
Health & Social Care (Double) / Health & Social Care (Single) / Mechatronics (Double) / Mechatronics (Double) / GCSE Maths
3D Art & Graphic Design (Double) / 3D Art & Graphic Design (Single) / Extended Project / 3D Art & Graphic Design (Double) / Extended Project
Extended Project / Extended Project / Extended Project

Section3

Qualifications + Level / Awarding Body / Estimated Grade / Actual Grade (if known)

Section 4

Please tell us why you want to join Crewe Engineering and Design UTC

Section 5

Please tell us how/where you heard about us

Section6

Signature of Applicant / Date
Parent/Carers Signature / Date
Title / Parent Name ( Please print in block capitals)

Please return completed form with reference to:

Crewe Engineering and Design UTC Admissions,

Beth Bramhall,

West Street,

Crewe,

Cheshire,

CW1 2PZ

Guidance Notes

Crewe Engineering & Design UTC is fully committed to equalising opportunities and welcomes enrolments from everyone, irrespective of age, background, gender, disability or support needs. We are committed to safeguarding our learners, staff and visitors through providing a safe environment and safe working practices. If you need any advice on which study option is best for you or if you need help with applying, please contact us on

1. If handwritten, please complete the application in block capitals using a ballpoint pen, preferably black. If you need any help completing your form, please contact us on 01270 218150 or

2. Please enter date of birth and your age on 31 August 2017.

3. Home address - If you have a different address for correspondence, please write it on a separate sheet and attach it to the form. If you change address after you have made an application, please inform us so your details can be updated.

4. The ULN is a personal 10-digit number randomly generated and allocated to post 16 learners. It is anonymous and will remain with the learner throughout their lives so that, in the future, all their learning experiences, exam results and qualifications will be linked together.

5. Please enter the estimated grades for the subjects/courses you are currently following, or the actual grades of qualifications/examinations already taken. Please make sure you indicate the level of the course, i.e. GCSE, Foundation, Intermediate etc.

6. Please tell us how you heard about Crewe Engineering and Design UTC, e.g. through school, a friend, or an advert.

7. Please tell us why you want to join Crewe UTC, eg. What your interests are, future aspriations, etc.

Please keep this page for your reference