Gloucester Academy Sixth FormApplication Form 2018/19PLEASE NOTE: If not completed in full, this may be returned to you. If you need help completing this form please come in to the Academy. PLEASE COMPLETE ALL SECTIONS OF THE FORM IN BLOCK CAPITALS.

APPLICANT PERSONAL DETAILSMr/Miss/Ms etc: Applicants NOT born in the

United Kingdom please complete this section:Surname:

Forename(s): Country of birth:Date of birth: Your nationality:Address: Country of domicile:

Date of last entry to UK:Postcode: Emergency contact:Telephone: Mobile: Name:Email address: Telephone:

COURSE DETAILSWhat would you like to study?

Please choose up to three options in TOTAL from Option Blocks A, B, C and D by circling your choices.You may also choose one or both of the Additional Options as these sit outside the main timetabled option blocks.Both of the Additional Options are qualifications equivalent to an AS qualification (half an A-Level).

Option Block A Option Block B Option Block C Option Block D Additional Options

A-Level Biology A-Level Chemistry A-Level Art A-Level English

LiteratureExtended Project

Qualification

A-Level Drama & Theatre A-Level History A-Level French A-Level

MathematicsMathematics in

Context (L3 Core)

A-Level Politics A-Level Photography

A-Level Geography A-Level Sociology

A-Level Product Design

A-Level Psychology A-Level Physics

BTEC Level 3 Music

Performance

BTEC Level 3 Business Studies A-Level Spanish BTEC Level 3 ICT BTEC Level 3

Sport

BTEC Level 3 Applied Science

CTC Level 3 Health & Social

Care

WJEC Level 3 Food Science and

NutritionPlease use the space provided here to identify any courses you are interested in studying that we are not currently offering.

Foundation Year – the option of a foundation year including Maths and English GCSE resits can be discussed at

interview based on predicted grades. Your place on this will only be confirmed after Results Day in August.Note: all courses are subject to change based on student numbers and availability.

Gloucester Academy Sixth FormApplication FormPLEASE NOTE: If not completed in full, this may be returned to you. If you need help completing this form please come in to the Academy. PLEASE COMPLETE ALL SECTIONS OF THE FORM IN BLOCK CAPITALS.

MOST RECENT SCHOOL/COLLEGE EDUCATIONGive details of exams taken or

pending

SubjectType

e.g.GCSE / BTEC

Results Date achieve

d(if

applicable)

School/CollegePredicte

dActu

al

EMPLOYMENTPlease enter previous and present employment in date order (you may include details of voluntary work or work experience)

Employer’s name and address

Nature of work From (date) To (date)

Do you have a sibling or sibling(s) currently at Gloucester Academy?EDUCATIONAL REFERENCE DECLARATIONPlease give the name and address of your school or previous tutor.

I confirm that to the best of my knowledge the information given on this form is correct.

Name: Signature of applicant:Address: Date:

Signature of parent/guardian (if you are under 18):Date:

PLEASE RETURN THIS FORM TO:SU MULLINS, GLOUCESTER ACADEMY SIXTH FORM ADMISSIONS

GLOUCESTER ACADEMY, PAINSWICK ROAD, GLOUCESTER, GL4 6RNEMAIL: sixthformadmissions@gloucesteracademy.com

HOW DID YOU HEAR ABOUT GLOUCESTER ACADEMY SIXTH FORM? www.gloucesteracademy.com Visit to your school GA Facebook page School careers advisor Twitter Friend/relative Google Previous/current student UCAS Progress Internal Marketing within the Academy (e.g. Y11

Assembly) Other website (please specify)