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COUNCIL

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COUNCIL

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									Web Version APPLICATION FOR A PLACE AT A CHESHIRE EAST PRIMARY SCHOOL - SEPTEMBER 2010
For office use only - Date Received

You can apply online at www.cheshireeast.gov.uk
SURNAME FIRST NAME(S) DATE OF BIRTH SEX: M F

ADDRESS AT WHICH PUPIL IS RESIDENT During the admissions procedure you must notify School Admissions in writing of any change of home address. Where a place is offered based on the address given on the preference form but it is subsequently found to have changed because you have moved home, the place may be withdrawn. Places offered on the basis of fraudulent or intentionally misleading information will be withdrawn. Your statutory right of appeal will not be affected. if ……………………………………………………………………….. applicable Child’s current Nursery and LA (if applicable)

………………………………………………………..........................
Postcode…………… Phone No …………………….. …………… Length of time at this address: ………………Yrs…………..Mths

. ……..…………………School …….……………………… LA

NAME(S) OF PARENT(S) OR ADULT(S) WITH PARENTAL RESPONSIBILITY (CARERS) Mr/Mrs/Ms Initials Surname Daytime Telephone No: /Dr etc Mr/Mrs/Ms Initials Surname Daytime Telephone No: /Dr etc ADDRESS(ES) (if different from pupil’s address) and email address (where available)

SIBLINGS (and any other children living at the same address) A sibling means the brother, sister, stepbrother or stepsister, half brother or half sister living together as part of one household, already attending the preferred school and expected to continue at the school in the following school year. Name of Sibling School & year group Date of Birth

Is your child baptised Roman Catholic? (if yes, please send a copy of the Certificate of Baptism direct to the school) Does your child have a Statement of Special Educational Needs? Is the child Looked After by a Local Authority (in public care)? Please state which Local Authority.

Yes Yes Yes

No No No

Names of preferred CHESHIRE EAST SCHOOLS ONLY Please state 3 preferences in ranked order. (Do not include fee-paying independent schools) 1st Preference 2nd Preference 3rd Preference

Web Version Please tick any of the following reasons applicable to each of your preferences.
Reasons: Sibling (brothers and sisters) (provide details overleaf) Medical (supporting information must be provided) Religion/Faith (state denomination)…………………………………….
1 Preference
st

2

nd

Preference

3 Preference

rd

OTHER RELEVANT CIRCUMSTANCES Please include here any further information which you consider may be relevant to your reference(s). Continue on a separate sheet, if necessary. You may wish to make separate statements in support of each of your preferences. Please provide full details of dual residency.

VOLUNTARY (CHURCH) AIDED SCHOOL APPLICATIONS If you have stated a preference for a Voluntary (Church) Aided School you should also contact the preferred school as additional information may be required in support of your application. I declare that all the information which I have provided is true. I understand that any school place offered on the basis of fraudulent or intentionally misleading information may be withdrawn. I have read the Council’s information booklet on admissions. Signed……………………………………………………………… (Mr/Mrs/Miss/Ms/Dr etc.) Print Name……………………………………….. ……………… Date.……………………….

PLEASE RETURN THIS FORM TO: School Admissions, Cheshire East Council, Delamere House (EC) Delamere Street, Crewe CW1 2LL. If you require an acknowledgement please provide a stamped address envelope with your application. CLOSING DATE: 18 DECEMBER 2009 (Forms received after this date will be processed after all on time applications)
DATA PROTECTION ACT The Council maintains a Register Entry in respect of Education which includes the administration relating to pupils. Personal information provided on this form is treated in confidence and complies with the requirements of the Act. This information may also be shared with other local authorities VERIFICATION OF INFORMATION – the Council may verify information you have provided on this form which could involve contacting other departments of the Council who maintain appropriate records. In instances where the information provided is different from that held by them they may use the information on this form.


								
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