SANDWELL ACADEMY

APPLICATION FOR SIXTH FORM

SEPTEMBER 2019
Student personal information
Surname: Male: Female:
Forename(s):
Date of Birth: Current age:
Address:

Postcode:
Home Telephone: Mobile Telephone:
Parent email address:
Name of parent(s)/carer (to whom correspondence should be addressed)
Mr/Mrs/Miss/Ms
Current School:
UPN: (obtained from current school)

Academic information
Examinations to be taken 2019:

Exam GCSE, NVQ etc Subject Exam Board (if known) Estimated Grade

GCSE examinations already achieved

Exam GCSE, NVQ etc Subject Exam Board (if known) Grade

Do you have any physical, medical or learning difficulties for which you may need additional support?
No Yes If yes please attach details.
Student personal Statement
Please give further information e.g. interests. extra-curricular responsibilities that you wish to be
considered with your application. Please continue on a separate sheet if necessary.

BTEC Sport and Performing Arts applicants only

Please give any further information that you wish to be considered with your application. For example the level
of representation (District, County), experience you may have had with a professional club or professional
organisation (within the last 3 years), any recognised sport-related qualifications that you currently hold
(Leadership, National Governing Body Awards, Performing Arts activities outside school etc.)

Early indication of preferred courses / career

Please indicate the subjects/courses you may be interested in studying and future career aspirations.

Ethnic information (please tick). This is used for statistical purposes only.

White - British Any other mixed background Black - Caribbean

White - Other Asian - Indian Black - African

White and Black Caribbean Asian - Pakistani Chinese

White and Black African Asian - Bangladeshi Any other Ethnic Group, please specify

Please return this form to: Sixth Form Admissions Manager, Sandwell Academy,
Halfords Lane, West Bromwich, B71 4LG