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School leavers' online application form

Section 1: Personal Details

Title: *

First Name(s): *

Surname: *

Date of Birth: *

Sex: *

Male

Female

Address1: *

Address2: *

Address3:

Address4:

Postcode: *

Nationality: *

Have you lived in the UK or European Union for the last 3 years or more?: *

Yes

Ethnic Origin: *

Email address:

Home phone:

Mobile:

Section 2: Choice of Course

Have you had an interview with Connexions in School?:

Yes

Your Chosen Course:

If no, would you like further advice and guidance?:

Yes

Section 4: School/Qualification Details

Name of school/college currently attending/last attended:

If other...:

Form/Tutor Group:

School Leavers' Qualifications

Examination Results (please state predicted grades if you are in Year 11 or achieved grades if you have left school)

Subject

Subject:

Subject1:

Subject2:

Subject3:

Subject4:

Subject5:

Subject6:

Subject7:

Subject8:

Subject9:

Subject10:

Subject11:

Level

Level:

Level1:

Level2:

Level3:

Level4:

Level5:

Level6:

Level7:

Level8:

Level9:

Level10:

Level11:

Grade

Grade:

Grade1:

Grade2:

Grade3:

Grade4:

Grade5:

Grade6:

Grade7:

Grade8:

Grade9:

Grade10:

Grade11:

Year of Exam

Year of Exam:

Year of Exam1:

Year of Exam2:

Year of Exam3:

Year of Exam4:

Year of Exam5:

Year of Exam6:

Year of Exam7:

Year of Exam8:

Year of Exam9:

Year of Exam10:

Year of Exam11:

Section 5: How you found out about us

Section 6: References

If you are still at school, your school will be asked for a reference. If you have left school please give name and address of a referee (not a friend or family member).

Name:

Address:

Postcode:

How is this person known to you?:

Section 7: Personal Statement

This should be minimum of 500 words.

Please attach your personal statement:

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