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1 Level 3 Application Form for 2019/20 Entry Please do not complete this form directly from your web browser but instead, download and save it as a word document. Please note: If you are statemented, or have an EHCP, please apply directly through your local authority. Your application will be subject to the following criteria: 1. Meeting the academic entry requirements, as advertised on our website. 2. The Academy being consulted formally by the local authority, that we are able to meet the student s needs. Surname: First name(s): Date of Birth (01/09/2002)-31/08/2003) Gender (please tick the appropriate box) Female Male Prefer not to say Current school: UPN: ULN: UCI No: Your UPN, ULN and UCI can be obtained from your school's Examinations Officer. If you attend an independent school, you should be able to at least obtain your UCI number. Please your completed application form to admissions@uclacademy.co.uk ensuring you put Level 3 Application Form in the subject field. THE DEADLINE FOR APPLICATIONS IS THURSDAY 31 ST JANUARY 2019

2 Section 1: Student s Personal Details Surname: Forename: Date of Birth: Address: Postcode: Mobile number: Home telephone number: address: Section 2: Parent/Guardian s Contact Details Title: Forename: Surname: Relationship to student: Address: Post code: Mobile number: Home telephone number: address:

3 Section 3: Choice of Courses Please indicate your four preferred subjects of the choices below. Refer to the Academy website and discuss your choice with your teachers and parents/guardians. Check with your school or careers advisors whether your prospective career/higher Education route requires specific entry qualifications. Please ensure your choices are made with reference to the course synopses which can be found at the following link: and see the entry requirements below. Biology Chemistry Computer Science Drama Economics Engineering English Literature Fine Art Further Mathematics Geography Government & Politics History Mandarin Mathematics Music Philosophy Physics Psychology Sociology Spanish German Minimum Entry Requirements You must be able to offer at least six GCSEs at Grades 5-9, including English and Mathematics (with a minimum of 3 Grade 5 s) and meet the following minimum entry requirements for each subject you wish to study. Biology Grade 6 in Biology or a Grade 7-9 in Double Science/Core and Additional Science, and a Grade 6 in GCSE Maths Chemistry Grade 6 in Chemistry or a Grade 7-9 in Double Science/Core and Additional Science and a Grade 6 in Maths Computer Science Grade 6 at GCSE in Mathematics Drama Grade 6 in GCSE English Literature. Please note, a preference will be given to those who also achieve a Grade 6 in GCSE Drama and a Grade 6 in GCSE English Language Economics Grade 6 in GCSE English Language and Grade 6 in GCSE Maths Engineering Grade 6 in both Core and Additional Science (equivalent to two GCSEs) English Literature Grade 6 in GCSE English Literature and a Grade 6 in English Language Fine Art Grade 6 in GCSE Art and Design Further Mathematics Grade 8 in GCSE Mathematics Geography Grade 6 in GCSE Geography History Grade 6 in GCSE in History Mandarin Grade 6 in GCSE Mandarin Mathematics Grade 7 in GCSE Mathematics Music Grade 6 in GCSE Music or Grade 5 Theory and Grade 5 in your main instrument Physics Grade 6 in GCSE Physics or Grade 7-9 in Double Science/Core and Additional Science and a Grade 7 in GCSE Maths Sociology Grade 6 in any Humanities subject and a Grade 6 in English Language Spanish Grade 6 in GCSE Spanish

4 Section 4: External Examination Record Subject GCSE (Double, single or short) Date (MM/YY) Estimated grade if not taken (i.e. predicted GCSE Grade) Final result if taken Date of final result if taken (MM/YY) Please note that if this section is not completed and your predicted grades not confirmed by your current school we will not be able to process your application

5 Section 5: Current Qualifications Please list any other relevant current qualifications and grades obtained if applicable. Please note this does not include SATS results. Subject/Course (indicate higher, Intermediate, Foundation, etc if relevant) Qualification Date (MM/YY) Section 6: Present School Details Name of your current school: Are you currently in Year 11? No If you have left school, please give the name of the school and the date of leaving: If you have left school, please give the reasons for leaving your last school and give details of what you have been doing since you have left: Do you have a sibling at The UCL Academy? No If yes, name of your sibling: What year group is your sibling enrolled in:

6 Section 7: Equality statement (Optional) Do you have a disability, medical condition, learning difficulty or learning need which we need to be aware of in order to provide appropriate support? Wheelchair user ADHD Speech Difficulty Hearing impairment Asperger s Dyslexia Visual Impairment Autism/Autistic Spectrum Dyscalculia Mental health Issues Other: English as an additional language (EAL/ESOL) Other (Please specify below) Medical condition which significantly affects daily life (please specify): Have you received any SEN support at your current school? No Have you been granted access arrangements for examinations? No If yes, what arrangements do you have: Scribe Word processor Extra time Other If other, please specify: Please note: This information does not count against your application. Section 8: Equal Opportunities monitoring (Optional) Completion of this section will help us fulfil our general duty under the Race relations (Amendments) Act 2000 to eliminate unlawful discrimination, to promote equality of opportunity and promote good relations between people of different racial groups. This information is collected on behalf of the Department for Education for their statistical use in the monitoring of equal opportunities. Please indicate by placing a tick in the box next to the description which you feel most closely describes your ethnic origin: Asian or Asian British- Bangladeshi Asian or Asian British Indian Asian or Asian British - Pakistani Asian or Asian British Other Asian Black or Black British Caribbean Black or Black British other Black Chinese or Chinese British Prefer not to say Mixed White and Asian Mixed White and Black African Mixed White and Black Caribbean White- British White Irish White Other White Other ethnic group

7 Section 9: Funding Eligibility What is your nationality (as stated on your passport)? Do you have a parent who is in the Armed Forces? No Are you or have you ever been considered a previously Looked After Child? No Have you been permanently resident in the UK or EU for the past 3 years? No If No, please state where you have been in last three years: Is there any restriction on the time you may stay in the UK? No If, please state the reason why: Section 10: Other Schools/Colleges applied to: Many students apply to more than one place their school sixth form, employment, two or more colleges etc. This will not affect whether you are offered a place at The UCL Academy or not, but helps us know your alternative plans so that we have sufficient places in September, for you and for others. Please list all the places applied to, including this Academy, in the order of your preference:

8 Section 11: Confirmation of application Data Protection: The school complies with the data protection laws for holding personal data. The school has a duty to protect this information and to keep it up to date. The school is required to share some of the data with the Local Authority and the DfE. In signing this application, you are giving you consent to us to use this data and if you are offered a place at The UCL Academy, to share information on your progress with your parent/guardian. Please confirm the following points: I confirm I have requested a completed confirmation of my predicted grades from a member of staff at my current school. Please note, we will be unable to process your application until a completed Predicted Grade Form is received from your current school, this form can be found on our website and must be returned from your school. I understand that if I am offered a place at the Academy, it is conditional upon receiving the necessary grades: I understand that if my application is successful, I must provide my valid passport/other official proof of identity, and my original examination results at the time of enrolment: Signature of Application (please type signature) Date: Support of Parent/Guardian Have you discussed this application and the applicant s proposed courses with your child. I support this application and will ensure that the Academy s regulations will be followed: Signature of Parent/Guardian (please type signature) Date:. Important Information The deadline for applications is Thursday 31 st January Please note that the application deadline is subject to extension at The UCL Academy s discretion. Submission - Please your completed application form to admissions@uclacademy.co.uk Conditional Offers All provisional enrolments are conditional on achieving specific grades at GCSE. Conditional offers will be confirmed in writing. Enrolment Applications must provide original documentary evidence of GCSE results and proof of identity during enrolment process which will take place in August Failure to provide all this information will mean that we are unable to guarantee the confirmation of your offer.