Domestic Application Form

Student Details

Name *

First

Last

What gender do you identify as? *

Date of Birth *

Email *

Phone *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you a British Passport Holder? *

Yes
No (please answer question below)

If you are not a British Passport Holder do you hold settled status in the UK?

Yes
No

You will be asked to provide evidence of your settled Status

Parent Details

Parent 1 title

Name of Parent 1 *

First

Last

Relationship to Student *

Phone *

Email *

Address (if different from above)

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parent 2 title

Name *

First

Last

Relationship to Student *

Phone *

Email *

Address (if different to above

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact

Name

First

Last

Relationship to student

Phone

Email

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Course Applying For

Year of entry

Year 12 applicants - Anticipated A Level subjects

Education History

Current / Previous School *

Date Joined *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

We will require a reference from your previous / current school - Please provide us with the name and email address of your preferred contact *

Medical and Support Needs

Do you have a medical condition eg. Chronic conditions, allergies, asthma, diabetes? *

Yes (please submit further details)
No

Do you have a disability?

Yes (please submit further details)
No

Do you have Special Educational Needs? *

Yes (please submit further details)
No

If you answered Yes to any of the above, please upload supporting evidence here

Drag & Drop Files, Choose Files to Upload

Alternatively you could provide further details here

Application checklist and declaration

We require the following section to be completed in order to process your application - Please check that you have:

Completed all sections of the application form *

Yes

Please upload a copy of your latest school report - Please ensure the file is clearly named

Drag & Drop Files, Choose Files to Upload

Please upload a copy of your passport or birth certificate - Please ensure the file is clearly named

Drag & Drop Files, Choose Files to Upload

Please confirm that you have read the Privacy Policy *

Yes

Student Signature *

Clear Signature

Date *

Parent 1 Signature *

Clear Signature

Date *

Parent 2 Signature *

Clear Signature

Date *

Student Details

Parent Details

Emergency Contact

Education History

Medical and Support Needs

Application checklist and declaration

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