APPLICATION FORM FOR SIXTH FORM - SEPTEMBER 2022 ENTRY
Please note: if you are statemented, or have an EHCP, please apply directly through your local authority.
All applications will be subject to the following criteria:
1. Meeting the academic entry requirements as advertised on our website.
2. The Academy being consulted formally by the local authority, that we are able to meet the students' needs.

Please also note conditional offers will be made after the application closing date.
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Email *
Student Surname: *
Student Forename *
Date of Birth (01/09/2005 - 31/08/2006) *
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Gender: *
Current School: *
EQUALITY STATEMENT (Optional) - Please note: This information does not count against your application.
Do you have a disability, medical condition, learning difficulty or learning need which we need to be aware of in order to provide appropriate support?
If other, please specify
Medical condition which significantly affects daily life (please specify)
Have you received any SEN support at your current school?
Clear selection
Have you been granted access arrangements for examinations?
Clear selection
If yes, what arrangements do you have?
If other, please specify
EQUAL OPPURTUNITIES MONITORING (Optional)
Completion of this section will help us fulfil our general duty under the Race relations (Amendments) Act2000 to eliminate unlawful discrimination, to promote equality of opportunity and promote good relations between people of different racial groups. This information is collected on behalf of the Department forEducation for their statistical use in the monitoring of equal opportunities.                                                  Please indicate by placing a tick in the box next to the description which you feel most closely describes your ethnic origin:
Clear selection
UPN *
ULN *
Home Address *
Please ensure you insert your full address
Post Code: *
Mobile number *
Email Address *
PARENT/CARER DETAILS
Parent title: *
Parent Full Name: *
Parent Telephone number: *
Parent Email Address: *
Sibling name (if currently attending The UCL Academy)
Sibling Current Year Group:
Sibling Date of Birth:
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A level Subject Choices: (Please choose four at this stage) *
Required
Predicted GCSE Grades Subject and Grade
Subject 1 *
Predicted Grade *
Required
Subject 2 *
Predicted Grade *
Required
Subject 3 *
Predicted Grade *
Required
Subject 4 *
Predicted Grade *
Required
Subject 5 *
Predicted Grade *
Required
Subject 6 *
Predicted Grade *
Required
Subject 7
Predicted Grade
Subject 8
Predicted Grade
Subject 9
Predicted Grade
Subject 10
Predicted Grade
PERSONAL STATEMENT - Use this opportunity to tell us what motivates you and what your interests are, Tell us about your plans for the future and why you are applying to The UCL Academy (maximum of 700 characters/approx 100 words). *
Confirmation of Application - Signature *
Date: *
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A copy of your responses will be emailed to the address you provided.
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