BRIGG SIXTH Atherton Way FORM Wrawby Road Brigg Brigg North Lincolnshire North Lincolnshire DN20 8AR DN20 8DS A PARTNERSHIP BETWEEN SIR JOHN NELTHORPE SCHOOL AND THE VALE ACADEMY Directors: Sir John Nelthorpe School: The Vale Academy: Mr. M. O. Mosey Miss A Savage/ Mrs J Keeler 01652 656551 01652 294511 Email: [email protected] Email: [email protected] [email protected] Application for Entry to Full-Time Courses for September 2018 How to Apply 1. Please remember when completing an application form to use a black pen, write clearly and check the dates and spelling. It is sometimes helpful to write your answers in rough first of all on a spare form or scrap paper. 2. If you need help to complete an application form then see your Form Tutor, Careers Co- ordinator and Careers Advisor. 3. Applicants should complete sections A to F. 4. Every student who completes an application form is guaranteed an interview. 5. Your completed application form should be handed in/posted to the main office at the school you are applying to. BRIGG SIXTH Atherton Way FORM Wrawby Road Brigg Brigg North Lincolnshire North Lincolnshire DN20 8AR DN20 8DS A. Personal Details Please tell the college at once if you change your address, telephone number or email address after completing this application. Family Name:………………………………………………………………………………………………………………………………….. Male/Female:………………………………………………………………………………………………………………………………….. First Names:…………………………………………………………………………………………………………………………………….. Date of Birth:…………………………………………………………………………………………………………………………………… Address:…………………………………………………………………………………………………………………………………………… ………………………………………………………………………………………………………………………………………………………… Home Telephone…………………………………………………. Mobile Number:……………………………………………….. Email:……………………………………………………………………………………………………………………………………………….. School:………………………………………………………………………………. Tutor Group:……………………………………. B. Subjects or Vocational Courses Studied Subject/Vocational Course Qualification Predicted Grade Completion Grade Actual Grade BRIGG SIXTH Atherton Way FORM Wrawby Road Brigg Brigg North Lincolnshire North Lincolnshire DN20 8AR DN20 8DS C. Programme of Study Please indicate the course/subject you are interested in. Please indication your preference. (1-4, 1 = highest priority, 4 = Lowest priority) Students are advised to study 3 subjects, although all applications will be assessed on an individual basis. Course/Subject Preference Why have you chosen these courses? Include your career aims if known. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. D. Interests, Experience and Achievements Work Experience: …………………………………………………………………………………………………………………………………………………………... ……………………………………………………………………………………………………………………………………………………………. BRIGG SIXTH Atherton Way FORM Wrawby Road Brigg Brigg North Lincolnshire North Lincolnshire DN20 8AR DN20 8DS Part Time Work: ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. Hobbies, Leisure and/or Voluntary Activities: ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. Personal Statement: Include information about yourself that is relevant to your application to be a Sixth Form Student. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. E. Data Protection Have you been suspended or excluded from a school or college? Yes/No Do you have a criminal conviction? Yes/No Health Do you consider that you have any medical condition/disablement? Yes/No If yes, please describe: …………………………………………………………………………………………………………………. BRIGG SIXTH Atherton Way FORM Wrawby Road Brigg Brigg North Lincolnshire North Lincolnshire DN20 8AR DN20 8DS ……………………………………………………………………………………………………………………………………………………………. Do you consider that you have a learning difficulty? Yes/No Is yes, please describe: ……………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. Equal Opportunities Monitoring Please tick in box Asian Black other White British Bangladeshi Chinese White Other Black African Indian Other Black Caribbean Pakistani Prefer not to say If other please state F. Additional Needs Any information given here will be treated confidentially. If you prefer not to write anything down here, you might like to seek help or guidance at the interview. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. ……………………………………………………………………………………………………………………………………………………………. Brigg Sixth Form Addresses Sir John Nelthorpe School The Vale Academy Wrawby Road Atherton Way Brigg Brigg DN20 8DS DN20 8AR Tel: 01652 656551 Tel: 01652 294511 BRIGG SIXTH Atherton Way FORM Wrawby Road Brigg Brigg North Lincolnshire North Lincolnshire DN20 8AR DN20 8DS Mr M Mosey Miss A Savage/Mrs J Keeler [email protected] [email protected] .