Years 10 and 11 Application Form

Years 10 and 11 (Young Learners) Application Form

Application form for Years 10 and 11 (14-16 Young Learners)

Course Details
Which year are you applying for?*
Course choice:*
Course choice:*
Which campus are you applying for?
Which year group are you applying for?*
Career Ambition (if known):
Where did you hear about Brooklands College?*
Personal Details
Name*
Prefix First Name Surname
Date of Birth*
DD slash MM slash YYYY
Age on 31st August*
Email
Address*
Mobile Number:
Name of Parent/Guardian*
Prefix First Last
Parent/Guardian Email:*
Parent/Guardian Mobile Number:*
Parent/Guardian Home Telephone Number:
Relationship to Student:*
Education
Are you currently:*
Please complete this section if you are home educated:
Name of school most recently attended:*
Leaving date:*
DD slash MM slash YYYY
Reason for leaving:*
Are you registered with the Local Authority?*
Please select yes or no
Name of Local Authority:*
Contact Name (if known):
Contact Email (if known)
Please complete this section of you are currently attending school
Te application must be completed in conjunction with the school. Brooklands College will contact the school for further information on receipt of the application.
Name of school:*
Name of school contact:*
Position/Role of school contact:*
Email address:
I confirm I have discussed the application with the school:*
- Yes
If you have not yet discussed the application with the school, please do so before submitting this form.
Disabilities, medical conditions and learning support
Do you have a disability or medical condition?*
If yes, please provide brief details:
Do you have an EHCP?*
Have you received any support at secondary school?*
Have you received exam access arrangements, i.e. extra time?*
Do you require any specialist equipment?*
Other
Are you in the care of the local authority or leaving care team?*
Do you have parent/carer responsibilities?*
Do you have a criminal record?*
Nationality:*
Ethnicity*
Signature
Date
DD slash MM slash YYYY

Brooklands College Weybridge Campus

Heath Road, Weybridge, Surrey KT13 8TT

Brooklands College Ashford Campus

Stanwell Road, Ashford TW15 3DU

Call

01932 797 700

info@brooklands.ac.uk

Years 10 and 11 Application Form

Years 10 and 11 (Young Learners) Application Form

Course Details

Personal Details

Education

Please complete this section if you are home educated:

Please complete this section of you are currently attending school

Disabilities, medical conditions and learning support

Other