SIXTH FORM APPLICATION2018 – 2019

Student DetailsSurname: Forename(s):

Address: Date of Birth:

Home Tel No:Student Mobile No:Parent Mobile No:

Postcode: Male / Female:

Current/Previous School: Headteacher:

Name of Parent/Carer:Student Personal Email (not a school one):

Parent Email:

Do you have any physical, medical or learning difficulties for which you may need additional support?

YES / NO(please attach details if ‘YES’)

A-Levels

Mathematics P.E.English Literature GeographyChemistry HistoryPhysics MusicBiology BusinessFrench PsychologyComputer Science Philosophy & EthicsDrama SpanishArt

Vocational Qualifications(equivalent to 1 A Level)

National Subsidiary Diplomas

BTEC Applied ScienceBTEC BusinessBTEC Creative Digital MediaBTEC SportBTEC Health and Social CareBTEC Performing Arts

Extended Diploma(equivalent to 3

A-Levels or 3 National Subsidiary Diplomas)

BTEC Health & Social CareBTEC Childcare

Please note that, while we make every effort to provide the full range of courses on offer, we reserve the right to add, change or cancel course offers at any time depending on take up and the availability of resources

I wish to undertake the following route: A-Levels Vocational Extended (You can mix A-Level & Vocational subjects)

Subject ChoicesPlease indicate three courses that you would like to study in preference order and at least one reserve subject (A-Level & Vocational routes). (Note: in exceptional circumstances we may consider four subjects)

First Preference:Second Preference:Third Preference:Reserve Subject (1):Reserve Subject (2):

If your grades do not meet our criteria we may well be able to offer you a Foundation route which is for One Year. If successful it can allow you to undertake further Level 3 courses. This involves GCSE resits in English and/or Maths and a BTEC National Certificate which is equivalent to 1 AS Level. BTEC subjects might include:

Applied Science Business Health & Social Care Sport

GCSE Exams studied and results (estimated and/or actual)

Subject GCSE

BTEC

Estimated Grade Actual Grade

Give details of the additional examinations taken, e.g. Music, DoE etc.

Please give details of your future career plans (if known)

Where / how did you find out about Abraham Darby Academy?Open Evening / AdvertKnow an existing studentBusOther (please state)

Ethnic Information (please tick). Used for statistical purposes onlyWhite – British Any other mixed background Black – CaribbeanWhite – Other Asian – Indian Black – AfricanWhite & Black Caribbean Asian – Pakistani ChineseWhite & Black African Asian – Bangladeshi Any other Ethnic Group (please state)White & Asian Asian - Other

Nationality Used for statistical purposes only

Signature: Date:

Please return your application by 8 th January 2018 to:-

Mr N Robins, Head of Sixth FormAbraham Darby AcademyIronbridge RoadMadeleyTelford TF7 5HX

Mrs Julie Pettifer, Sixth Form AdministratorTel: 01952 386056www.abrahamdarbyacademy.org.uk

Email : ad.sixthform@taw.org.uk