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application form 2012 (DOC)

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									                                Strode’s College
                                                                                       office use only
      2012                                                                             Rec.________________
    Application                 High Street, Egham, Surrey TW20 9DR
                              Tel. 01784 437506      Fax 01784 471794                  Adm. No. __________
      Form                         Email: admissions@strodes.ac.uk
     2012                           Web Site: www.strodes.ac.uk                        12 / ________________
 APPLICATIONS
    WILL BE                       Principal: Frank Botham B.A. PhD.                    I/V _________________
ACCEPTED FROM
                        Application Form: Please return directly to Strode’s College   ____________________
 26 APRIL 2011
   ONWARDS              School Reference Form: Please give to your current school


Family Name __________________________________ First name(s) ___________________________________

Date of Birth __________________________________ Gender: M / F          National Ins. No. __________________


Home Address (for correspondence)
___________________________________________________________________________________________

______________________________________________________________ Post Code ______________________

Home Phone No. ______________________________          Student Email __________________________________

Student mobile phone no. _______________________

 st
1 Parent/carer full name: _______________________________________ Relationship to you: ______________

Emergency Phone No. _______________________________ Email ______________________________________

Home address (if different to above)
______________________________________________________________________________________________
 nd
2     Parent/carer name: __________________________________________ Relationship to you: ______________

Emergency Phone No. _______________________________ Email ______________________________________

Home address (if different to above)
______________________________________________________________________________________________

Present / Previous School ___________________________________ Local Education Authority: ____________
                                                         (To whom is the household Council Tax paid?)
Address of School _____________________________________________________________________________

PROPOSED COURSES AT STRODE’S: Please consult the Course Guide or our website
Subject Choices                                Level (e.g. AS, A2, BTEC Nat/1st, GCSE etc)




GCSE OR OTHER EXAMS TAKEN/TO BE TAKEN: (grades obtained or predicted if available)
Subjects (and level) Date (Mth/Yr) Grade Subjects (and level)              Date (Mth/Yr)                 Grade




Are there any dates when you would be unable to attend for interview?
ALL STUDENTS PLEASE STATE YOUR NATIONALITY HERE (What passport do you hold?)
Tuition is free for students’ aged 16-19 on full-time courses who have ‘home student status’, as fees are fully remitted
by the YPLA (Young People’s Learning Agency). Fee status and other entitlements usually depend upon nationality
and residence.

Nationality ____________________________________________ Passport Number _________________________

Ethnic Group: To assist us in monitoring Equal Opportunities, how would you describe yourself?
Bangladeshi               Black Caribbean                        Mixed White/Caribbean                 White British                
Indian                    Black African                          Mixed White/African                   White Irish                  
Pakistani                 Other Black                            Mixed White/Asian                     White – Other                
Other Asian               Chinese                                Other Mixed                           Any other                    
                                                                                                          Prefer not to state          
Religion: _______________________________ or Prefer not to state 

INDIVIDUAL SUPPORT – ALL STUDENTS please tick the relevant box
We provide a range of support for students with learning difficulties (e.g. Dyslexia, Aspergers), disabilities (e.g.
mobility or visual impairment), medical conditions (e.g. epilepsy, ADHD, diabetes), mental health difficulties and those
identified as Gifted and Talented or part of the Aim Higher programme.
 I would like Learning Support to contact me before my interview to discuss my needs
 I would like to discuss my support needs at interview                                        Gifted and Talented
 I would like to advise you of a medical condition at interview                               Aim Higher Programme
 I have the following access needs at my interview. (Please give details) ____________  National Citizen Service
 None of these

Do you have a brother / sister who is currently at Strode’s or has recently left?
CAREER INTERESTS:                                                    PART-TIME WORK UNDERTAKEN:



APPLICATION STATEMENT: (This can be written, or continued, on a separate sheet of paper if you wish)
Please write a careful statement below giving the reasons for your application to Strode’s College. Include any
interests/hobbies you have outside your studies and any responsibilities you have undertaken in school and
elsewhere. Mention any difficulties that you may have had in your schooling such as interruption for long illness, or
time abroad.




The College believes that a strong partnership exists between staff, students and parents/carers, which
underpins student achievement. It is therefore College policy to share student review data and other relevant
information with parents/carers. In signing this application form:
a. You agree to the sharing of information between staff, parents/carers and students.
b. You undertake to inform the College of any change in circumstances which might affect fee remission

Applicant’s Signature: _____________________________________________________ Date: ________________
For Parent / Carer: I have discussed the contents of this form with my son/daughter/ward and I will support her/him
in continuing full time education.

Name: __________________________ Signed: ________________________________ Date: ________________
        Data Protection Act 1984 & FOIA 2000. This information may be processed electronically and used for administrative purposes.
                              The College disposes of such information held on students 7 years after they leave.
               2012 APPLICATIONS WILL BE ACCEPTED FROM 26 APRIL 2011 ONWARDS

								
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