Bishop Walsh Catholic School Sixth Form Application Form September 2017 Pupil s Surname: Christian names: Date of Birth: / / Current school: FULL names of parent or legal guardian: (1) Home address: Home telephone: Mobile numbers: (1) Post Code: (1) Email address: FULL names of parent or legal guardian: (2) Home address: (2) Post Code: Home telephone: (2) Mobile numbers: (2) Email address: Mobile telephone numbers are an essential contact point as the school operates Groupcall which is a truancy check and a way of passing on other information. The school will now be sending Newsletters and some other correspondence by email. Please provide the details of at least one emergency contact, other than parents/guardians, in case of illness or accident. Contact Name: (1) (2) Address: Phone number: Relationship to pupil:
Student s ethnicity: Student s Nationality Student s religion: Refugee Status: Country of birth: First Language: English Additional Language (if English is NOT the first language at home please indicate here): Home Language: Parish in which you live (not necessarily the parish church you attend): All students will be expected to attend, regularly and punctually, all assemblies, community religious functions, religious education classes, etc. Has student made 1 st Confession?: Yes/No 1 st Communion?: Yes/No Been confirmed?: Yes/No Date of Confirmation: Does the student have any relative(s) at Bishop Walsh? Please state name(s) and House Group: Does the student have any medical condition or allergies that the school should know about, eg asthma, poor hearing etc: Details of medical need or allergy: Family Doctor s Name: Telephone number: Address: Does the student have any Special Educational Need (SEN)? Yes/No What are the details of this SEN? Has this been diagnosed? Yes/No
What evidence is there to support this diagnosis? (please include a copy of any relevant documentation) Details of evidence: Please include copies of diagnosis letters from hospital /doctor if there is a medical issue or SEN for example diagnosis of ADHD, ASD or medical (hearing/visual impairment). Does the student have extra time in all examinations? Yes/No What evidence is there to support this? Details of evidence: Please include a copy of a letter from the student s current school- from their SEN Co-ordinator Has the student ever been entitled to Free School Meals? Yes/No If yes, when? Please provide details of any other financial support; In the Sixth form we offer a 16-19 Bursary to students who are eligible for such support. Students can find out more about this and collect the information pack once enrolled in our Sixth Form. If there is any other information (for example any child protection information, mental health issues etc.) that you feel we as a school should be made aware about so that we can aim to support your son or daughter as best we can? Please provide details below: If you wish to speak to someone about anything that you have written in the section above please call the school and ask to speak with Mrs Hayes, Key Stage 5 Learning Mentor.
If NOT a current Year 11 student at our school please find out from your current school your UPN and ULN: UPN- The Unique Pupil Number ( UPN ) is a 13-character code that identifies each pupil in the localauthority-maintained school system. ULN The Unique Learner Number (ULN) is a 10-digit reference number which is used alongside and to access the Personal Learning Record of anyone over the age of 14 involved in UK education or training. UPN: ULN: Media and Careers Information: -I do give permission for my child s contact details to be passed to Mrs Sarah Forsyth, Bishop Walsh s Careers Advisor. This is to enable independent assessment and guidance (IAG) on future careers options. -I do give permission for my child s photograph to appear in a newspaper report or article about an event at the school. -I do give permission for my child s full name and age to appear in a newspaper report or article about an event at the school. -I do give permission for my child s full name or photograph to appear on the school website, school newsletter or display of their work in school. Please contact the school if there is any information in this section regarding media and careers that needs to be discussed further. Signed: Date:
Making your choices Full Name: Pathways of entry: Pathway 1 Students will study four AS courses. They will take these examinations in the summer of Year 12 and then discontinue one course. They will then take the full A Level examinations in the summer of Year 13. A minimum of six A*-C GCSE grades including English and Mathematics (at grade 5 or above) and meeting the subject-specific entry requirements detailed on each page of the prospectus is needed for entry to this pathway. Pathway 2 Students will study a mixture of four AS and BTEC Level 3 vocational courses. They will take these examinations in the summer of Year 12 and then discontinue one course. They will then take the full A Level examinations in the summer of Year 13. A minimum of five A*-C GCSE grades including English and Mathematics (at grade 5 or above) and meeting the subject-specific entry requirements detailed on each page of the prospectus is needed for entry to this pathway. Pathway 3 Students will study three BTEC Level 3 vocational courses. Students will take these examinations in the summer of Year 12 and then discontinue one course. They will then take the full A Level examinations in the summer of Year 13. A minimum of five A*-C GCSE grades including English and Mathematics (at grade 4 or above) and meeting the subject-specific entry requirements detailed on each page of the prospectus is needed for entry to this pathway. Christian Life: All A level students follow a Religious Education Level 3 ASDAN qualification (which is worth up to 40 UCAS points) which has a timetabled one-hour lesson each week in Years 12 and 13. The majority of students will take four subjects. Please place numbers in the table below that correspond to your preference of course where 1 is your top preference. PLEASE MAKE FIVE CHOICES in the table below. We will endeavour to timetable your four choices. The fifth choice is a reserve in case we are unable to successfully timetable your four choices.
Subject Order of Order of Subject preference preference Art and Design Further Mathematics* Biology Geography Business Studies German BTEC L3 Applied Science Government & Politics BTEC L3 Business BTEC Health and Social Care OCR National Technical in History Sport and Physical Activity Chemistry Mathematics Computer Science Media Studies Dance Music Drama & Theatre Studies Music Technology Economics Physics English Literature Psychology English Language and Religious Studies Literature Fashion Spanish French *In order to study Further Mathematics students must also study Mathematics In addition to your options above, do you also wish to take? : Core Maths yes / no (please circle) The Extended Project Qualification (EPQ) yes / no (please circle) Pupil Signature: Date: Please return your completed application form to school for the attention of Mrs Marston-Smith, Head of Sixth Form c/o Mrs Bethell by no later than 4.00pm on Wednesday 15 th March 2017. Information on this form will be held by us under the terms of the data protection act and used for managing the application process, planning our provision at sixth form and to monitor equality of opportunity for all of our applicants.