ARCHBISHOP BLANCH C.E.HIGH SCHOOL

TechnologyCollege with Applied Learning Status & the National Standard Award for Enterprise

MOUNT VERNON ROAD LIVERPOOL L7 3EA

FROM SEPTEMBER 2015 - 80 EARLE ROAD, LIVERPOOL L7 6HQ

tel: 0151 233 7373; email: ;website:

APPLICATION FORM FOR ADMISSION

YEAR 7, SEPTEMBER 2016

(closing date for receipt of completed application form at school - 31October 2015)

Full Name of Child: / Date of Birth:
Permanent Home Address:
Postcode:
Present School & Address: / School Tel No:

SECTION 1GENERAL INFORMATION

All applicants must complete at least ONE of the sections below, PLUS sections 1.6, 1.7 & 1.9:

1.1 CATEGORY ‘A’ APPLICATIONS

I wish my daughter to be allocated a place because: Tick ONE box below

She has a Statement of Special Education Need where, following consultation with the Local Authority, the school is named in the Statement (Category A1i) / Places allocated automatically
as required on receipt of relevant proof
She is a Child Looked After by the Local Authority (Category A1ii)
She is an adopted child who was previously Looked After by the Local Authority (or has become subject to a residence or special guardianship order) (Category A1iii)
I am a member of staff employed at ArchbishopBlanchSchool for 2 or more years, or have been employed to meet a skills shortage (Category A2) / Priority may
be given

1.2 CATEGORY ‘B’ APPLICATIONS - RELIGIOUS Tick ONE box below

I wish my daughter to be considered for admission because ofChristian commitment
(Category B1/a) / Please complete
Section 2
I wish my daughter to be considered for admission because of commitment to Islam
(Category B2a) / Please complete
Section 3
I wish my daughter to be considered for admission because of commitment to another World Faith (Category B2b) / Please complete
Section 4

1.3 CATEGORY ‘C’ APPLICATIONS - APTITUDE

Note: Aptitude tests will be carried out for ARTorMUSIC in September and the results made known to applicants prior to the necessary completion of this section(please refer to Admissions Policy for further guidance) Tick ONE box below

I wish my daughter to be considered for admission because of her aptitude in MUSIC (Category Ci)
I wish my daughter to be considered for admission because of her aptitude in ART (Category Cii)

1.4CATEGORY ‘D’ APPLICATIONS – EXCEPTIONAL MEDICAL/SOCIAL NEEDTick box below

I wish my daughter to be considered for admission because of EXCEPTIONAL MEDICAL/SOCIAL NEED / Please complete
Section 5

1.5 CATEGORY ‘E’ APPLICATIONS – EXPRESSION OF INTEREST Tick box below

I wish to express a preference for my daughter to be considered for a place at the school
(If there are not enough applications to fill categories A-D, places will be allocated to those parents who express an interest under this section)

1.6THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS:

Name of Parent/Carer / Relationship to Child / Address / Telephone
Home / Mobile
Postcode:
Email address

1.7 Please complete ONE boxbelow

I live in the Liverpool Education Authority area and have named ArchbishopBlanchSchool as one of the 3 schools on the Authority’s preference form. / YES/
NO
I do not live in the Liverpool Education area. My Local Authority is______.
I have named ArchbishopBlanchSchool on my Education Authority’s preference form. / YES/
NO
I live within the Diocese of Liverpool.
If you have answered NO, please state the Diocese in which you live: / YES/
NO

Notes:

1.8.1The Governors have defined ‘Christian Church’ to be any Church in membership with, or sharing the statement of belief of Churches Together in Britain and Ireland, or in full sympathy with its Trinitarian stance.

1.8.2Likewise, the Governors have defined ‘parent’ to be a parent, grandparent/spiritual parent or carer/legal guardian of the girl for whom admission is sought.

1.8.3Aptitude tests will be carried out for ART or MUSIC in September. Closing date for APTITUDE TEST forms to be returned – 9thSeptember 2014 (see aptitude form for return address)

1.8.4This application form must be returned to ArchbishopBlanchSchool by 31stOctober2014

1.8.6PLEASE CHECK YOU ARE SUBMITTING THE CORRECT INFORMATION:

CHILDREN LOOKED AFTER BY THE LOCAL AUTHORITY or PREVIOUSLY LOOKED AFTERCHILDREN PRIOR TO ADOPTION: Appropriate written confirmation from the Local Authority, Adoption, Residency or Special Guardianship order.

CHRISTIAN APPLICATIONS:A Ministerial Reference for each church listed in Section 2.2 (blue form/s); please request extra reference forms if you worship in more than one church.

In exceptional circumstances, and only if an applicant cannot obtain written confirmation of attendance at church from a priest, minister or religious leader, the governors will accept the ‘parents’ self certification of their family’s church attendance. You are advised to carefully read the covering letter on the front of the Self Certification form (bright blue) before completion – see Admissions Policy for additional information regarding evidence.

MUSLIM APPLICATIONS: A Muslim Leader’s Reference for each place of worship the parent has attended listed in Section 3.2; (pale yellow form/s); A reference from the Headteacher of each Madrassa thechild has attended listed in Section 3.3 (pale green form/s);

please request extra forms if you or your child attend more than one place of Worship or Madrassa

OTHER WORLD FAITH APPLICATIONS:A Faith Leader’s Reference for each place of worship the family has attended listed in Section 4 (pink form/s);

please request extra forms if you or your child attend more than one place of Worship

EXCEPTIONAL MEDICAL/SOCIAL APPLICATIONS: A reference of supporting evidence from aregistered health professional such as a doctor or a social workerlisted in Section 5 (lilac form/s)

THE SECTION BELOW MUST BE COMPLETED BY ALL APPLICANTS

1.9 I am aware that the School Admissions Code allows schools to withdraw the offer of a school place

if parents/carers give fraudulent or intentionally misleading information. The school reserves the

right to verify information given to them by the applicant.

Signature of parent/carer: Date:

This document is available in an alternative format (e.g. large print).

Please address your request to the school office

SECTION 2CHRISTIAN APPLICATIONS

2.1How many churches have the child or parent attended during the period that reference forms have been

submitted to support the application: ______

2.2Please complete the details below for each church in Section 2.1; continue on another sheet if necessary.

Name of Church
/ Name of Minister/Leader / Address & Telephone Number of Minister/Leader /
Dates attended
from / To
Tel No:
Denomination:
Tel No:
Denomination:
Note: 1) You must enclose a paleblue Minister’s Reference Form for each church named above
2)In exceptional circumstancesonly, if an applicant cannot obtain written confirmation of attendance at church
from a priest, minister or religious leader, the governors will accept the parents’/carers’ self certification of their
family church attendance(bright blue form). In this instance, you are encouraged to submit as much supporting
evidence as possible e.g. certificate of reception into the church, baptism, communion, altar server certificates or
letters of support from Sunday School/Little Church etc. The governors reserve the right to verify information.

SECTION 3MUSLIM APPLICATIONS

3.1How many places of worship has the child or parent attended since January 1st 2012? ______

3.2Please complete the details below for each Mosque the parent has attended in Section 3.1.

Name of Mosque
/ Name of Leader / Address & Telephone Number
of Leader /
Dates attended
from / To
Tel No:
Tel No:
Note:1) You must enclose a pale yellow Leader’s Reference Form for each place of worship named above.

3.3 Please complete the details below for which Madrassa the child has attended in Section 3.1

Name of Madrassa
/ Address & Telephone Number
of Headteacher /
Dates attended
from / To
Tel No:
Name of Headteacher:
Tel No:
Name of Headteacher:
Note:1) You must enclose a pale greenMadrassa Headteacher’s Reference Form for each place of worship named above.

SECTION 4 OTHER WORLD FAITH APPLICATIONS

4.1How many places of worship has the family attended since January 1st 2011? ______

4.2Please complete the details below for each place of worship the familyhas attended in Section 4.1

Place of Worship
/ Name of Leader / Address & Telephone Number
of Leader /
Dates attended
from / To
Tel No:
Religion:
Tel No:
Religion:
Note:1) You must enclose a pink Leader’s Reference Form for each place of worship named above.

SECTION 5 EXCEPTIONAL MEDICAL/SOCIAL NEED APPLICANTS

5.1You may briefly outline the specialreasons for your application, however, it is essential that the reasons are supported by a reference from suitably qualified professional(s) e.g. social workeror doctor

Name of Professional Referee / Organisation / Address & Telephone Number
Position held: / Tel no:
Position held: / Tel no:
Note:1) You must enclose a lilac Reference Form(s) from suitably qualified health professional(s) e.g. socialworkeror
Doctor