Dereham Sixth Form Application Form

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Please use this form to apply for courses to start in September 2020. All course information is available in the Prospectus section of our website.

Personal Details

Forename *

Surname *

Other Name *

Have you already applied through HelpYouChoose? *

Yes

Date of birth *

YYYY

Current High School *

Email *

Mobile phone *

Home phone *

Home Address *

Nationality

Please state your nationality *

Have you lived in the UK or EU for the past 3 years? *

Yes

If no, date of entry to into the UK or EU

YYYY

Do you have any immigration restrictions?

Yes

Clear selection

Are you a registered asylum seeker?

Yes

Clear selection

Have you lived abroad because family is in the British Armed Forces? *

Yes

Equal Opportunities

Gender

Female

Male

Clear selection

Is English your first language? *

Yes

Are you looking after someone at home? *

Yes

Ethnicity *

White British

Black British

Indian

Pakistani

Bangladeshi

Chinese

African

Caribbean

Gypsy or Irish traveller

Any other background

Other:

Emergency Contacts

Name of First Emergency Contact: *

Relationship to you: *

Father

Mother

Step Father

Step Mother

Other Relative

Social Worker

Carer

Religious/Spiritual Contact

Headteacher/Teacher

Other:

Daytime Phone: *

Evening Phone: *

Address if different from home address above:

Name of Second Emergency Contact:

Relationship to you: *

Father

Mother

Step Father

Step Mother

Other Relative

Social Worker

Carer

Religious/Spiritual Contact

Headteacher/Teacher

Other:

Daytime Phone *

Evening Phone

Address if different from home address above

Educational History

Are you still attending school? *

Yes

If no, please enter the date you left

Name of current high school *

Year and form group *

Head of Year/House

Start date

Qualifications and Predicted Grades (please state if not GCSE)

If these are not GCSEs please give details

Work Experience

Personal Statement

Do you have an intended career or career interests

Extra-curricular activities you've done at school

eg. Prefect, clubs, sporting activities etc

Are you currently, or have you recently been living in care?

Yes

Clear selection

Do you require further information on transport services to Dereham?

Yes

Clear selection

Course Choices

Please enter a minimum of 3 and a maximum of 5 courses. Subjects are timetabled in blocks - only choose one subject in a block unless instructions say otherwise.

A Levels/BTEC you would like to apply for: *

Art, Craft & Design - block 3

Biology - block 3 or 4

Business Studies - block 3

Chemistry - block 2 or 5

Children's Play, Learning, Development (BTEC) - diploma course (2 A level equiv) - block 6

Children's Play, Learning, Development (BTEC) - cert course (1 A level equiv) - block 6

Computer Science - block 3

Dance - block 2

DESA (BTEC Sport) - 3 A level equiv - block 6

Design & Technology - block 5

Drama and Theatre Studies - block 4

Economics - block 2

English Language & Literature - block 5

English Literature - block 1

Fine Art - block 6

French - block 1

Further Mathematics - blocks 4 and 6 - MUST choose both blocks (also includes Maths A level)

Geography - block 3 and 5

Graphics - block 5

Health & Social Care Single (Extended Certificate) - block 1

Health & Social Care Double (Diploma) - block 5 - MUST also choose HSC EC in block 1 as well

History - block 1 or 3

Law - block 2 or 4

Mathematics - block 1 or 4

Media Studies - block 2

Music (BTEC) - block 6

Philosophy & Ethics - block 4

Photography - block 1

Physical Education - block 3

Physics - block 1 or 2

Psychology - block 4, 5 or 6

Sociology - block 3

Spanish - block 2

Other:

Required

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