Please Complete in Block Capitals Using a Ballpoint Pen

Please complete in block capitals using a ballpoint pen.

Section 1 Surname Forename (s) Title DOB (dd/mm/yyyy)

Home Address Age (on 31st Aug 2018)

Postcode Home Telephone

Parent Address (If different from child)

Mobile (Student) Mobile (Parent)

Email (Student) Email (Parent)

Current School Unique Learner Number (ULN)

Section 2 Please choose one provisional option from each of the 5 columns (Options are subject to change, including new subjects on offer.) Option 1 Option 2 Option 3 Option 4 Option 5

Design Engineering Maths A Level Maths A Level Business Studies GCSE Maths (Double)

Design Engineering Mechatronics Product Design Engineering (Single) Core Maths (Double) (Double)

Level 2 3D Art & Graphic Mechatronics Extended Project Physics Engineering Design (Single) (Double)

Chemistry Extended Project Extended Project Computer Science

Extended Project

Section 3

Qualifications + Level Awarding Body Estimated Grade Actual Grade (if known)

Section 4

Please tell us why you want to join Crewe Engineering and Design UTC

Section 5

Please tell us how/where you heard about us

Section 6 Signature of Applicant Date

Parent/Carers Signature Date

Title and relationship to student Parent Name ( Please print in block capitals)

Please return completed form with reference to:

Crewe Engineering and Design UTC Admissions, Beth Bramhall, West Street, Crewe, Cheshire, CW1 2PZ Guidance Notes

Crewe Engineering & Design UTC is fully committed to equal opportunities and welcomes admission from everyone irrespective of background, gender, disability or support needs. We are committed to safeguarding our learners, staff and visitors by providing a safe environment and safe working practices. If you need any advice on which pathway is the best option or assistance with the application, please contact us on 01270 218150 or email [email protected]

1. If you’re handwriting the application form, please complete in black pen and in block capitals 2. Please make sure when entering parent information you include the title and relation to student 3. Please make sure to tell us where you heard about our UTC, eg. Word of mouth, advertising, friends/family 4. When completing the why you want to join us, please make sure to include your interests, the reason for choosing the UTC and future aspirations 5. Options – To form the Technical Baccalaureate (Tech Bacc) you must choose Maths, 1 Engineering discipline and Extended Project. You must pick only one option from each block.

If you’re predicated a 4 you will need to opt for Core Maths, if you’re looking at 5 or above you will need to choose A Level Maths.

If you achieved below a 4 in Maths or English, you will need to resit your GCSE.

Engineering Technical

You must choose one of the following: Engineering (Single) Design Engineering (Double) Mechatronics (Double)

If you choose a double Technical Award, it will take up two option blocks. For example if you pick Design Engineering, you must pick it in option 2 and option 4

Please keep this page for your reference