APPLICATION FORM - 2020 / 2021

Thank you for your interest in Connell Co-op College.

If you have any questions, please contact our admissions team at conl-admissions@coopacademies.co.uk
or call 0161 231 9200.

Once we have received your application, we will email you within six weeks to confirm receipt. Should your
predicted grades meet our entry requirements for your chosen courses, we will then invite you to interview.

All our correspondence will be via email, so it is important your email address is written clearly and
correctly.

Please note that the deadline for this application is Friday 31st January 2020.

Personal Information:
 Last name:

First name:

Middle name(s):

Preferred name:

Date of birth:

Gender:

Address:

Postcode:

Mobile number:

Email address:
(IN CAPITALS)

Secondary school:

Please list the GCSE subjects that you are taking this year:

Subject: Predicted Grade:

Proposed course(s) you wish to take:
Please visit our website www.connell.ac.uk for the full list of courses and combinations we offer.

In order of preference, please list the colleges that you have applied to:

Career Pathway:
If you have an idea of what you would like to do after you leave college, please give details below.

Do you normally receive any extra support with your learning?

Please tick:

YES

NO
If yes, please provide details:

Do you have any medical or physical conditions that we need to be aware of?
Please tick:

YES

NO

If yes, please provide details:

Parent/carer details:

Full name:

Relationship to student:

Mobile number:

Email address:

Student declaration:

I declare that the information given in this application is correct.

Signed: ________________________________________________

Date: _________________________