2019 Online Application Form

Applicant Information

Full Name:*

First

Last

Date of Birth:*

/

day

month

year

Gender:*

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?*

If YES, when did you return to the UK?

Parent/Guardian Information

Name 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 History

Name 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. French

Level e.g. GCSE

Projected Grade

Actual Grade

1

2

3

4

5

6

7

8

9

10

11

12

13

14

What You Want To Study

Please 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:*

Second Preference:*

Third Preference:*

Fourth Preference:*

Your Motivations And Aspirations

Please 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:*

Referee

Please 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 Questions

We 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):

Information

If 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: