VIRGO FIDELIS SIXTH FORM
Application Form
PLEASE WRITE IN CAPITAL LETTERS
Student’s surname: ______Student’s first name: ______
Date of birth: ______Place of birth: ______
Religion: ______Nationality: ______
Student’s Email: ______Student’s mobile no.: ______
Home tel no:______
Home address:______
______Postcode ______
FATHER / GUARDIAN / OTHER( please circle) / MOTHER / GUARDIAN / OTHER
(please circle)
Surname and title
(Mr, Mrs, Dr, etc)
Forenames
Postal address
( in full)
Postcode
Telephone (home)
Mobile no.
Name of present school: ______
Address of present school: ______
______
It is important that you ask at your school office for the following numbers before submitting your form.
Unique pupil number (UPN) ______
Unique learning number (ULN) ______
Candidate number (UCI) ______
Do you have any siblings currently/or previously in the School? YES / NO
Have you lived in the UK / EU for the last three years? YES / NO
If no, how long have you been a resident? …………………………………………year(s)…………………………….month(s)
Have you ever attended another UK school? YES/NO
Do you have a visa? YES/ NO If yes, what type? ………………………….When does it expire?......
Where did you hear about Virgo Fidelis?......
Please fill in the following details so that we may establish your requirements, interests and needs in our Sixth Form.
What GCSEs have you passed in Year 10/11 including grades? Please attach proof of grades.
Subjects / Exam Board / Actual GradeWhat GCSEs are you entered for in Year 11?
Subjects / Exam Board / Grade Predicted / Signatureof Staff Member
State your reasons for choosing this Sixth Form and provide any additional information to support your
application e.g. career aspirations, interests, responsibilities held in school, activities etc.
You may attach a supporting statement on a separate sheet.
Please tick the type of the course(s) in which you are interested:
GCE A Level Vocational Level 3 Vocational L2 GCSE
Please provide the names & addresses of two people whom we may contact for references. One of these must be supplied by your current school.
Reference 1Reference 2
Name: / Name:School Name: / Name:
Address: / Address:
Postcode: / Postcode:
Telephone: / Telephone:
Position: / Position:
Virgo Fidelis is committed to ensuring that all our students are treated fairly. We seek to provide additional learning support where required e.g. dyslexia, health or mental health needs, learning or mobility difficulties.
Please indicate the specific support you require and if any special arrangements might need to be made for public exams.
______
______
Do you have Special Educational Needs? Yes / No Please give brief details:-
Is English your first language? Yes/No If no, do you have any support for this in school?
I declare that, to the best of my knowledge, the information I have given is a true and correct record and I give my consent to Virgo Fidelis Convent Senior School to process this information in accordance with the Data Protection Act 1998.
Student’s Signature: …………………………………………………………………….. Date …………………………………………………
Parent/Guardian Signature: ……………………………………………………….... Date …………………………………………………
DATA DETAILS
Country of Birth:……………………………………………………..
Nationality:……………………………………………………………
Ethnicity
Bangladeshi□Indian□Pakistani□
Any other Asian Background□African □Caribbean□
Any other Black Background□Chines e□Cornish □
Traveller of Irish Heritage□Gypsy/Roma□Irish□
British□Any other White Background□
White and Asian□White & Black African □
White & Black Caribbean□Any other Mixed Background□
Any other Ethnic Background (please state) ……………………………………………………………..
Language spoken at home: ……………………………………………………………………………………
Proficiency in English (please circle)
Fluent Competent Developing Competence Early Acquisition New to English
Information supplied may be used for registered purposes under the terms of the Data Protection Act.
Student’s Signature: …………………………………………………………………….. Date …………………………………………………
Parent/Guardian Signature: ……………………………………………………….... Date …………………………………………………