Ashton Campus Ashton Community Science College Aldwych Drive Ashton-on-Ribble Preston PR2 1SL Tel: 01772 730284 Fax: 01772 513006 sixthform@ashtoncsc.lancs.sch.uk
Application Form for Sixth Form at Ashton Community Science College First Name (s) : ……………………………………………………… Date of birth : ……………………………………
Surname : …………………………………………………………… Male
Female
Address : …………………………………………………………………………………………………………………………………………………….. …………………………………………………………………………………………………………………… Postcode: ……………………….... Home telephone number : ……………………………………… Your mobile number :………………………………..………… Parents / Carers Name (s) : …………………………………………………………………………………………………………………………. Parent/Carers home phone number : ……………………………………………… Mobile : …………………………………………… Nationality : …………………………………………
Name and address of your current school : ………………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………… If you are not in education please state your last school/college, address and date of leaving: ……………………………………………………………………………………………………………………………………………………………………
Do you require any support or special facilities () ?
Yes
No
If yes please specify :…………………………………………………………………………………………………………. Do you have any health problems () ?
Yes
No
If yes please specify :…………………………………………………………………………………………………………. Are you in care or have you just left care? Yes
No