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Primary School Certificate

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					                            Starting Infant or Primary School
                          Application Form for Luton Residents

   FOR A STATUTORY SCHOOL PLACE AT A COMMUNITY, FOUNDATION OR
    VOLUNTARY AIDED INFANT/PRIMARY SCHOOL FOR CHILDREN BORN
                   BETWEEN 1/9/2006 AND 31/8/2007

  To the Parents/Carers of                                              CATCHMENT AREA SCHOOL:




Please thoroughly read through the ‘Starting School’ booklet before completing this application
form. The booklet contains important information on the admissions process and it is essential that
you follow the procedures detailed in the booklet.

Luton parents/carers must use this form to request a place at a community, foundation or voluntary aided
infant/primary school.

This application form must be returned to your first preference infant/primary school, if this is in Luton, by
15 January 2011. If your first preference school is outside of Luton, the form must be returned to Luton
Borough Council’s Admissions Team by 15 January 2011.

When you return your application form, the school or Admissions Team will need to see all of the following
original documentation (please do not post the original documents to schools or to Unity House).

        Your child’s birth certificate;

        A recent (within the last 12 months) Child Benefit CH84TS Form which shows your
         address and your child’s name. If you have not received a recent CH84TS Form, you can obtain
         a copy by telephoning the Child Benefit Helpline on 0845 302 1444. Alternatively, you can
         provide your Working Tax Credit/Child Tax Credit award letter for 2010/11, this must include the
         pages that shows the name of your child;

        A recent (within the last 3 months) gas bill or electricity bill or water bill which shows your
         address. Alternatively, you can provide your 2010/11 council tax bill which shows your address.
         Please note, the Admissions Team do not accept telephone bills, credit card or bank
         statements as proof of address.
                                                                                   (Please see overleaf)

  FOR ADMISSIONS USE ONLY: PLEASE DO NOT WRITE IN THIS
                         BOX
1ST PREFERENCE DISTANCE:             2ND PREFERENCE DISTANCE:            3RD PREFERENCE DISTANCE:




       REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO                             1
                     NEED TO COMPLETE THIS APPLICATION FORM
If you specify St Joseph’s Infant School, St Martin de Porres Primary School, St Margaret of Scotland
Primary School or Sacred Heart Primary School as a preference you will need to complete both the Starting
School application form and the blue supplementary form included in the pack. Also, please ensure that a
copy of your child’s baptismal certificate is provided.

The Admissions Team will be operating drop-in sessions at Unity House where parents/carers will be able to
bring in the original documents to be photocopied. The sessions are as follows:

                                 Tuesdays & Thursdays 2pm – 4pm
                                Wednesdays & Fridays 10am – 12noon

Help in completing this form is available from the Admissions Helpline on 01582 548016, Monday to Friday,
                                           between 10am and 4pm.

             PLEASE NOTE – The Admissions Team will use the most recent application (either
     on-line or hard copy) submitted before 15 January 2011, for the starting school admissions
                                               round.




       REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO                     2
                     NEED TO COMPLETE THIS APPLICATION FORM
            Starting Infant or Primary School Application Form


REMEMBER: You
                                        Child’s Details
should only
complete this
application form if
your child was
born between           First Name(s):
1/9/2006 –
31/8/2007


                       Last Name:



                       Date of Birth:



                       Gender:                   Male                   Female


           Name of nursery or early years unit
           presently attending:



           You must provide your first preference school or the Council with proof of
           address and proof of date of birth. If you do not provide the relevant
           documentation to verify your address, your application will not be processed, if
           your preferred schools are oversubscribed. In addition, if you do not provide your
           child’s birth certificate your application will not be processed. Please see the
           ‘Starting School’ booklet for further details.

                      Home Address:


                                        Postcode:


                      Parent’s E-mail
                      address:




               REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO         3
                             NEED TO COMPLETE THIS APPLICATION FORM
     Starting Infant or Primary School Application Form
     Name of First Preference School: If you are stating a school outside of Luton as a first
     preference, please give the school’s full name and address, including postcode.




     If your child has a sibling (brother or sister), who will be attending your first preference school or its
     linked junior school in September 2011, please specify their first name, last name, date of birth,
     gender and address:

                             SIBLING 1                        SIBLING 2                       SIBLING 3
FIRST NAME(S):

LAST NAME:

DATE OF BIRTH:

GENDER:

ADDRESS:

      Please note, if your child has a sibling attending your first preference school and you do not complete
              the details above, your application will not be considered under the sibling criterion.


     Name of Second Preference School: If you are stating a school outside of Luton as a second
     preference, please give the school’s full name and address, including postcode.




     If your child has a sibling (brother or sister), who will be attending your second preference school or
     linked junior school in September 2011, please specify their first name, last name, date of birth,
     gender and address:

                             SIBLING 1                        SIBLING 2                       SIBLING 3
FIRST NAME(S):

LAST NAME:

DATE OF BIRTH:

GENDER:

ADDRESS:

         Please note, if your child has a sibling attending your second preference school and you do not
          complete the details above, your application will not be considered under the sibling criterion.
        REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO                                  4
                      NEED TO COMPLETE THIS APPLICATION FORM
      Starting Infant or Primary School Application Form

     Name of Third Preference School: If you are stating a school outside of Luton as a third
     preference, please give the school’s full name and address, including postcode.




     If your child has a sibling (brother or sister), who will be attending your third preference
     school or linked junior school in September 2011, please specify their first name, last
     name, date of birth, gender and address:

                             SIBLING 1                       SIBLING 2                      SIBLING 3
FIRST NAME(S):

LAST NAME:

DATE OF BIRTH:

GENDER:

ADDRESS:

          Please note, if your child has a sibling attending your third preference school and you do not
          complete the details above, your application will not be considered under the sibling criterion.



       Additional information – Reasons for preference(s) e.g. religious convictions, medical,
       social reasons. (Please continue on a separate sheet if required.)




        REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO                             5
                      NEED TO COMPLETE THIS APPLICATION FORM
Starting Infant or Primary School Application Form

              Special Educational Needs

              My child has a current Statement of Special Educational Needs
              and I have made my preference known at Review.

                Yes                         No


              Medical

             Are you enclosing a medical certificate for your child?

                Yes                         No




              Children in Care

             Is your child ‘looked after’ by a Local Authority?

                Yes                         No

             If yes, please state which local authority is responsible for the pupil:



             Please also provide a letter from your child’s social worker confirming their
             legal status and details of the local authority responsible for the child.

             Name and telephone number of social worker:




 REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO               6
               NEED TO COMPLETE THIS APPLICATION FORM
   Starting Infant or Primary School Application Form


Checklist:


   I have read and understood ‘Starting Infant or Primary School’ booklet for parents.

   I have stated a first, second and third preference.

   If I have specified St Joseph’s Infant School, St Martin de Porres Primary School, St
    Margaret of Scotland Primary School or Sacred Heart Primary School as a preference, I
    have completed the blue supplementary form included with the main application form
    and enclosed a copy of my child’s baptismal certificate.

   If I have stated a preference for a school(s) outside of Luton, I have checked the
    school’s admission arrangements to see if I need to complete a supplementary form.

   I have supplied my first preference school or the Council with the documentation
    specified in the ‘Starting Infant or Primary School’ booklet.

   I understand that if I do not provide the relevant documentation to verify my address, my
    application will not be processed, if my preferred schools are oversubscribed.

   I understand that if I do not provide my child’s birth certificate to verify their date of birth,
    my application will not be processed.

   I understand that if I have not stated that my child has a sibling (brother or sister)
    attending one of my preferred school(s) my application will not be considered under the
    sibling criterion.

   I have attached a medical certificate for my child (only for those parents seeking
    admission for their child on medical grounds).

   I have provided dates or names in the places where they are requested on the form.

   I have checked to make sure that all the information I have given is correct.

   I have signed and dated the form.




     REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO                       7
                   NEED TO COMPLETE THIS APPLICATION FORM
   Starting Infant or Primary School Application Form

          PLEASE ENSURE THE FORM IS SIGNED BEFORE RETURNING

I certify that all the information I have given on this application form is correct. I understand that any
false or deliberately misleading information given on this form and/or supporting information may
render this application invalid, or lead to the offer of a place being withdrawn.


             Parent/Carer Details


Name of
Mother:


Name of
Father:




Home Tel                                           Mobile
No:                                                No:


Name of Applicant:
 e.g. mother, father, guardian’s name
 (Mr/Mrs/Miss/Ms - delete as appropriate)


 Applicant’s relationship to pupil:


 Do you have parental responsibility                YES               NO
 for the pupil?




 Signature of person                                             Print
 with parental responsibility:                                   Name:



 Date:




      REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO                    8
                    NEED TO COMPLETE THIS APPLICATION FORM
 This form must be returned to your first preference school or the Admissions
                          Team by 16 October 2009.
    Starting Infant or Primary School Application Form




        FOR ADMISSIONS / SCHOOL USE ONLY


       Birth Certificate:

                                           Signature                 Designation

       Utility Bill:
        (Council Tax/Gas/Electric/Water)

                                           Signature                 Designation

       Child Benefit CH84TS or
        Working Tax/Child Tax
        Credit award letter:
                                           Signature                 Designation

       Baptismal Certificate:

                                           Signature                 Designation

Date:


    FOR ADMISSIONS TEAM USE ONLY

Entered by:

Checked by:

        REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO   9
                      NEED TO COMPLETE THIS APPLICATION FORM
REMEMBER: IF YOU APPLY ON-LINE (www.luton.gov.uk/admissions) THERE IS NO   10
              NEED TO COMPLETE THIS APPLICATION FORM

				
DOCUMENT INFO
Description: Primary School Certificate document sample