identification
purposes only
Date Received:
The Grey Coat Hospital
Sixth Form Application Subject Choice Form
Section A – Personal Details of StudentThis section should be completed in BLOCK CAPITALS
Surname ……………………………………….Forename(s)…………………………………….
Female Male
Date of Birth…………………………………………………………………………………………..
Home Address…………………………………………………………………………………………………
......
Student telephone numbers…………………………………………………………………………
Email address…………………………………………………………………………………………
Current School………………………………………………Borough………………………………
Do you currently have a sibling attending The Grey Coat Hospital? Yes/No
Name of sibling…………………………………………………… Year and form………………
In order for us to support you at The Grey Coat Hospital Sixth Form please can you provide us with the following information:
Do you consider yourself to have a disability? If yes, please provide details
Do you have an EHCP? If yes please provide details
Are you in the process of applying for an EHCP? If yes please provided details
Do you consider yourself to have any special or additional needs e.g. dyslexia, dyspraxia, other additional support needs. If yes please provided details
Do you currently qualify for exam access arrangements? (eg extra time, a quiet room, use of a laptop etc)? If yes please provided details
Section B – Student’s Proposed Courses
Please fill in section below and list your Advanced Level subjects according to
order of preference
Order of preference: Subject Predicted Grade
1 ______
2 ______
3 ______
______
Reserve choice : ______
Section C – Parental Information
Name and address for communications:
Name of parent/guardian…………………………………………………………………………
Address ......
……………………………………………………………………………Post code ......
Contact telephone numbers ...... ………
Email address…………………………………………………………………………………………..
I confirm that all of the above information is correct.
I support this application.
Signature of parent/guardian Date
Section D– For All Applicants
List here the public examinations the applicant has already taken and those for which the candidate has been entered.
The Applicant’s current school should complete the predicted grade column.
Once the first three columns have been completed, please pass this Application Form to the Applicant’s Head of Year for completion.
Name
Position
Subject / Level GCSE including Tier of Paper / Date of Exam / Predicted Grade
to be completed by applicant’s Head of Year
Signature of Head of Year Date School Contact Number
Official School Stamp
Please return completed form by Friday 1st December 2017 to: The Grey Coat Hospital, Sixth Form Office,
98 Regency Street, Westminster SW1P 4GH, Telephone: 020 7969 1950
The Grey Coat Hospital Sixth Form Application Subject choice form 2018-19