Dereham Sixth Form Application Form
Please use this form to apply for courses to start in September 2019. All course information is available in the Prospectus section of our website.
Personal Details
Full Name *
Your answer
Have you already applied through HelpYouChoose? *
Current High School *
Your answer
Date of birth *
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Mobile phone *
Your answer
Home phone *
Your answer
Email *
Your answer
Home Address *
Your answer
Nationality
Please state your nationality *
Your answer
Have you lived in the UK or EU for the past 3 years? *
If no, date of entry to into the UK or EU
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DD
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Do you have any immigration restrictions?
Are you a registered asylum seeker?
Have you lived abroad because family is in the British Armed Forces? *
Equal Opportunities
Gender
Is English your first language? *
Are you looking after someone at home? *
Ethnicity *
Emergency Contacts
Name of First Emergency Contact: *
Your answer
Relationship to you: *
Daytime Phone: *
Your answer
Evening Phone: *
Your answer
Address if different from home address above:
Your answer
Name of Second Emergency Contact:
Your answer
Relationship to you: *
Daytime Phone *
Your answer
Evening Phone
Your answer
Address if different from home address above
Your answer
Educational History
Are you still attending school? *
If no, please enter the date you left
Your answer
Name of current high school *
Your answer
Year and form group *
Your answer
Head of Year/House
Your answer
Start date
Your answer
Qualifications and Predicted Grades (please state if not GCSE)
If these are not GCSEs please give details
Your answer
Supporting Information
Do you have an intended career or career interests
Your answer
Extra-curricular activities you've done at school
eg. Prefect, clubs, sporting activities etc
Your answer
Are you currently, or have you recently been living in care?
Do you require further information on transport services to Dereham?
Course Choices
Please enter a minimum of 3 and a maximum of 5 courses. Subjects are timetabled in blocks - only choose one subject in a block unless instructions say otherwise.
A Levels/BTECyou would like to apply for: *
Required
Your answer
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