External Applications

Please complete all fields marked with *

This form should be completed with your parent/carer present as we need some information from them.

Basic Student Details

Legal Forename* Legal Surname* Middle Name(s) Preferred Forename Preferred Surname Date of Birth* Gender* Student Email Address* Student Mobile Number Home Address* Postcode*

Family Details

Do you have any siblings already at the school?* If yes, please give details of their name and year group.

Parent/Carer 1:

Select one of the following* If other please state: Forename* Surname* Relationship to Applicant* If other please state relationship: Mobile Number* Home Number Work Number Email Address*

Parent/Carer 2

Select one of the following* If other please specify: Forename* Surname* Relationship to Applicant:* If other please state relationship: Mobile Number* Home Number Work Number Email Address Does this contact live with the applicant? If no please give contact's full address

Additional Information

Which Local Authority do you live in?* How will you travel to school?* Are you a looked after child?* If yes, which local authority has responsibility for you? Asylum Status* Do you have a parent/carer in the armed forces?* What is your Special Educational Needs Status* If you selected EHCP or SEN Support please give further details

Medical Information

Please give details of any medical conditions or dietary needs, including allergies, which we need to know about. Please write 'None' if you do not have any* Medical Practice Name* Medical Practice Address* Medical Practice Telephone Number* Do you consider yourself or your parent/carer to have a disability?* If yes please give further details

Ethnic/Cultural Information

Please select the category which best describes your ethnicity* Country of Birth* Nationality* First Language (which language is spoken at home)* Religion*

Education

Which Year Group are you currently in?* Current School* Date Attended From* Date Attended To* If you are coming from abroad, have you ever attended a school in the UK? (If yes please give details in the section above, this includes primary schools) Please give details below of any other schools you have attended (including primary) and the dates you attended them* Have you ever been excluded?* If yes please provide details

Please provide the following identity numbers. Your current school should be able to provide them.

Unique Learner Number (ULN) Unique Pupil Number (UPN) Please list all examinations that you will take this academic year and any qualifications you have already achieved

	Subject (including level)	Predicted Grade	Result Already Achieved?
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Course Information

Is Raynes Park Sixth Form your* Why do you want to study at Raynes Park Sixth Form?* Please give details of where else you have applied including whether they are 1st/2nd/3rd choice*

If you are expecting to achieve 5 Grade 5-9 including Maths and English and you meet the specific entry requirements of the subjects you wish to study please select four Level 3 courses.
If you are not predicted 5 Grade 9-5 and this includes English and Maths it is likely that you will need to retake your Maths and/or English GCSE. You should put these as your first two choices (or first choice if this only applies to either English or Maths).

Please put your course choices in order of priority*

	Subject
First Choice
Second Choice
Third Choice
Fourth Choice
Reserve

Is this application linked to the Fulham Football Academy?* Would you like to sit AS/A2 examinations in a home language?* If yes please state which language(s) Raynes Park Sixth Form is committed to supporting you and working well with your parents/carers. Is there anything else you think we should know to help us with this task?

Parental Consent

This section should be completed by the parent/carer who is filling out this application form with you.

In an emergency, it may not be possible to contact the parent/carer. In such circumstances, we ask that you authorise a member of the school staff to give consent to medical treatment recommended by the medical practitioners involved in the accident or emergency.

I authorise a member of Raynes Park High School staff to consent to medical treatment for my child on my behalf in an emergency.*I consentI do not consent

I authorise Raynes Park High School to use photographs and videos of my child in accordance with the school's policy.*I consentI do not consent

I agree that my child may use the ICT facilities and internet in accordance with the school rules regarding acceptable use.*I consentI do not consent

Parent/Carer Name* Date*

Applicant and ParentalAgreement

Applicant:

I have discussed the contents of this form with my parent/carer and am confident that the information supplied is correct in all respects.

Applicant Name* Select Date*

Parent/Carer

I fully support my child in continuing full time education.

Parent/Carer Name* Select Date*