KGV Application Form 2015

Office Use

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App made: ❑ Date App done: ❑ updated ❑

Received: ..........................................................................

KING GEORGE V COLLEGE

ProSolution:

STUDENT APPLICATION FORM STARTING 2015

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Scarisbrick New Road, Southport PR8 6LR Telephone: 01704 530601 Fax: (01704) 548656 E-mail: admissions@kgv.ac.uk

ABOUT YOURSELF Surname:

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First Name(s): Male

PARENT DETAILS

(Please use Block Capitals)

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Female

First parent Title e.g. Mr/Mrs/Dr etc: First name: Surname:

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Tel No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mobile No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Address (if different to student):

Postcode:

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Home Phone No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mobile Phone No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail:

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Nationality:

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Date of Birth: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Age on 1.9.15

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Have you been resident in the European Community for the last 3 years?

yes

Second parent Title e.g. Mr/Mrs/Dr etc: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

First name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Surname:

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Tel No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Mobile No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

E-mail: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Address (if different to student):

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We welcome students with Learning Difficulties/Disabilities. .......................................................................

Please tick if you: Have health problems

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Emergency contact (only if not parent/guardian):

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Have a learning difficulty requiring support You are in care or a care leaver

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Name:

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Daytime Tel No: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Relationship:

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YOUR EDUCATION

(year)

Present or last School/College . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . From:

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YOUR FUTURE

(year)

To:

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Please indicate future Careers/Higher Education Choice if possible

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YOUR INTERESTS Outside interests:

Activities in school: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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YOUR OPTIONS A LEVEL

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Which courses would you like to study at KGV College? (tick more than one box if undecided)

BTEC EXTENDED DIPLOMA

Subjects (list subjects in order of preference)

Subject Level 3

1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

EXAMINATIONS

(to be taken or already taken)

LEVEL: SUBJECT ACTUAL GCSE/ (indicate short course where appropriate) RESULT BTEC etc (if known) GCSE Mathematics GCSE

ESTIMATED LEVEL: RESULT GCSE/ BTEC

SUBJECT (indicate short course where appropriate)

ACTUAL RESULT

ESTIMATED RESULT

English Language

ETHNICITY INFORMATION

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Please tick one option below as appropriate: 31

White British

32

White Irish

43

Any Other Asian Background

46

Any Other Black Background

98

Any Other Ethnic Group

38

Any Other Mixed Background

34

Any Other White Background

47

Arab

41

Bangladeshi or British Bangladeshi

44

Black/Black British African

45

Black/Black Caribbean

42

Chinese

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39

Indian/British Indian

37

Mixed White and Asian

36

Mixed White and Black African

35

Mixed White and Black Caribbean

99

Not Stated

40

Pakistani or British Pakistani

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COURSE DISCUSSIONS All applicants attend a 20 minute course discussion with relevant subject staff to confirm their application and course choices. Please select your preferred options below which will be honoured as far as possible.

❑ Thursday 26th February 2015 ❑ Wednesday 4th March 2015 ❑ Tuesday 10th March 2015 ❑ Monday 16th March 2015 ❑ Monday 23rd March 2015 ❑ Monday 30th March 2015 Please indicate your preferred time(s): ❑ 4.30 - 5.30 ❑ 5.30 - 6.30 ❑ 6.30 - 7.30 Please select at least 2 dates when you would be available:

Date and time of appointment will be confirmed in due course.

DECLARATION I declare that the information given on this form, is correct to the best of my knowledge and that I agree to it being stored in electronic and manual form and being processed in accordance with the College’s registration under the Data Protection Act 1998 (this may include disclosure to those staff members of the College who have need to see it).

Applicant’s signature

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Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If you attend a KGV Partner High School, hand the form to the appropriate teacher. Otherwise, please have your applications with us by 12th December 2014. If you apply after this date we will still give your application full consideration, but will not necessarily be able to guarantee that places will still be available for your chosen subjects.