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Applicant's Information
First Name:
*
Middle Name(s):
Surname:
*
Date of Birth:
*
Gender:
*
Female
Male
Home Address:
*
Student Email Address:
*
Student Mobile Number:
*
Current Year Group:
*
Subject Selection:
What Pathway Are You Interested in?
*
A-levels only
BTEC Extended Diploma in Sport only
BTEC Diploma in Sport & 1 A-level combination
Which Subjects Are You Applying For?
*
If You Are Applying for Sport, which Sport do you Play and Which Position?
Have You Had a Careers Interview?
*
Yes
No
Do You Have a Particular Career Aim?
*
Enter Current Subjects and Predicted Grades:
*
Please Give Your Reasons for Applying:
*
Are you Looking for a Boarding Place?
*
Yes
No
Mother's Information - (In the case of there being no mother, please write N/A in the following boxes to move forward).
Mother's First Name:
*
Mother's Surname:
*
Do you have Parental Responsibility of the Child?
*
Yes
No
Mother's Home Telephone Number:
*
Mother's Mobile Number:
*
Mother's Email Address:
*
Name of Local Authority to which you Pay your Council Tax:
*
Are you a UK Service Personnel or other Crown Servant applying for a place as a result of a posting?
*
Yes
No
Father's Information - (In the case of there being no father, please write N/A in the following boxes to move forward).
Father's First Name:
*
Father's Surname:
*
Do you have Parental Responsibility of the Child?
*
Yes
No
Father's Home Phone Number:
*
Father's Mobile Number:
*
Father's Email Address:
*
Name of Local Authority to which you Pay Your Council Tax:
*
Are you a UK Service Personnel or other Crown Servant applying for a place as a result of a posting?
*
Yes
No
Emergency Contacts
Alternative Contact for Emergency Purposes
*
Number for Emergency Contact
*
Siblings at the Academy
Do you have a Brother or Sister at The Academy?
*
Yes
No
If you answered yes to the previous question; please write the name of your sister/brother here:
*
What Year Do They Study In?
Student's Current Education
What is the Name of Your Current School?
*
Address of Current School/College
*
How Long Have You Been There?
*
Started
To
Date
First Referee Name & Job Title (e.g. Head of Year):
*
First Referee Email Address:
*
First Referee Phone Number:
*
Second Referee Name & Job Title (e.g. Head of Year):
*
Second Referee Email Address:
*
Second Referee Phone Number:
*
UCI Number:
ULN Number:
UPN Number:
Pupil Premium Information
Were You Listed as Gifted and Talented?
*
Yes
No
Have You Been on Free School Meals in the Last 6 Years?
*
Yes
No
Are you 'looked after' by a local authority (e.g. foster care)?
*
Yes
No
If Yes, which local authority?
Have You Been Adopted From Care?
*
Yes
No
Special Educational Needs
Do You Have a Statement of Educational Needs?
*
Yes
No
SEN Status:
Do You Require Any of the Following Examination Access Arrangements When Sitting Exams?
*
Use of a scribe
Use of a laptop
Use of a reader
Extra
Other
No support needed
Travel & Lunch Infromation
Travel To/From School:
*
Car
Walk
Bus
Bike
Lunch Arrangements:
*
School Lunch
Free School Meal
Packed Lunch
Medical
Medical Concerns/History:
*
Doctor/Medical Centre Name and Address:
*
Additional Student Information:
Will You Be Able to Attend THA for a Minimum of 95% each Academic Year?
*
Yes
No
Student Home Language?
*
Student First Language?
*
Do You Speak/Write/Read Any Other Languages?
*
Do You Have Any Criminal Convictions or Pending Criminal Convictions?
*
Yes
No
How did you hear about The Harefield Academy?
*
Sixth Form Online Application Form
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Sixth Form Online Application Form
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