Years 10 and 11 Application Form

Years 10 and 11 Application Form students on school roll

Please use this form to apply: IT MUST BE COMPLETED BY THE SCHOOL

Personal Details
Name*
Prefix First Name Surname
Preferred Name (if applicable)
Name
Gender:
Nationality:*
Ethnicity*
Date of Birth*
DD slash MM slash YYYY
Current Age:*
Current Year Group:*
Student Mobile Number:
Parent Information:
Name of Parent/Guardian*
Prefix First Last
Relationship to Student:*
Email of Parent/Guardian:*
Mobile Number of Parent/Guardian:*
Home Telephone Number of Parent/Guardian:
Full Address*
Postcode*
Application discussed with parent/guardian*
Education
School:*
Name of Lead School Contact:*
Position:*
Phone:*
Email:*
Safeguarding Contact:*
Email*
Telephone:*
Attendance Contact:*
Email:
Telephone:
Course Details
Which year are you applying for?*
Which course would you like to apply for?*
Reason for student wanting to study at brooklands:*
Career ambition (if known):
When not at College, what will the student do?
All courses are part time (max of 13 hours)
If other, please specify
Predicted Maths Grade*
Predicted English Grade*
Exam Access Arrangments*
If yes, please provide details
Attendance:*
Please provide a record/summary of the attendance for the academic year
Behaviour:*
Please note any concerns re. behaviour
Disabilities, medical conditions and learning support
Does student have a disability or medical condition?*
If yes, please provide details, including whether any specialist equipment is required
Does student have an EHCP?*
If yes, please provide a brief outline of needs and name of LA. A copy must be submitted with the application. We will not be able to arrange an interview until we have checked that we are able to meet the needs of the EHCP
Has student received LSA support?*
Is student eligible for Free School Meals?*
Is student in the care of the local authority or Leaving Care Team?*
If yes, please provide brief details
Does student have parent/carer responsibilities?*
Are there any safeguarding concerns?*
If yes, please provide brief details
Does student have a criminal record or had any involvement with the police?*
If yes, please provide brief details
Other Agency Involvement i.e. social worker/CAMHS*
If yes, please provide brief details
Agreement
By submitting this form, the school agrees to support and fund the placement. Please contact pre-16-info@brooklands.ac.uk if you require details of the costs associated with the programme or would like a reference copy of the Service Level Agreement.
Name of person completing the form:*
Position:*
Email:*
Date*
DD slash MM slash YYYY
Phone

Brooklands Technical College
Weybridge Campus

Heath Road, Weybridge, Surrey KT13 8TT

Brooklands Technical College
Ashford Campus

Stanwell Road, Ashford TW15 3DU

Call

01932 797 700

info@brooklands.ac.uk

Years 10 and 11 Application Form

Years 10 and 11 Application Form students on school roll

Personal Details

Parent Information:

Education

Course Details

Disabilities, medical conditions and learning support

Agreement