2019 Online Application FormApplicant InformationFull Name:* First Last Date of Birth:*01020304050607080910111213141516171819202122232425262728293031 / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember / 201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901daymonthyearGender:*E-mail Address:*Current Address:*Postcode:*Phone (Home):*Phone (Mobile):*Have you lived abroad for a period of more than 6 months in the last 3 years?*SelectYesNoIf YES, when did you return to the UK?Parent/Guardian InformationName of a Parent/Guardian:* First Last Current Address (if different to above):Parent/Guardian Postcode:Parent/Guardian E-mail:*Parent/Guardian Phone (Home):Parent/Guardian Phone (Mobile):Relationship to you:*Your Educational HistoryName of your current school/last school that you attended full time:*Date of leaving OR date projected to leave: (e.g. August 2018):*Address of the school named above:*Please give details about which courses you are studying and your projected or actual grades:Name e.g. FrenchLevel e.g. GCSEProjected GradeActual Grade1234567891011121314What You Want To StudyPlease choose 4 A-Level courses you would like to study, ranking them in order of preference. If you’re not sure, don’t worry – put down what you think you’d like to do and we can discuss this at interview:First Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPerforming ArtsPESecond Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPerforming ArtsPEThird Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPerforming ArtsPEFourth Preference:*Choose SubjectBiologyChemistryPhysicsMathematicsFurther MathematicsComputer SciencePsychologyFrenchGermanSpanishEnglish LiteratureEnglish Lit & Language EconomicsGovernment and PoliticsGeographyHistoryPhilosophy and EthicsSociologyLawDrama and Theatre Studies BusinessPEYour Motivations And AspirationsPlease explain why you want to study these courses and any career aspirations you may have at this stage? (Max 75 words)*What attracts you most about applying for a place at Chapeltown Academy? (Max 75 words)*Please list any enrichment activities that you currently take part in AND any enrichment activities you would like the opportunity to try or continue with at the Academy:*RefereePlease provide details of a referee (most probably a school teacher) who we can contact for a reference:Referee Name:* First Last Referee Position:*Referee E-mail:*Referee Phone Number:Optional QuestionsWe are committed to meeting the needs of all learners. If consider yourself to have any learning difficulties or disabilities, please provide outline details:To assist with our equal opportunity monitoring, please let us know how you would describe your ethnic origin (e.g. White British):InformationIf you have any extenuating circumstances that you believe we should know about then please attach them to this form. Applications can be scanned and emailed to contact@chapeltownacademy.com or posted to Chapeltown Academy Admissions, Chapeltown Academy, Hydra Business Park, Nether Lane, Sheffield, S35 9ZX.Word Verification:SubmitReset