Sixth Form Application Form

Personal Details

Surname

Forename(s)

Male/Female

Male

Female

Date of Birth

Present School

Home Address

Postcode

Telephone Number

Mobile Number

Parent(s)/Carer

Parent/Carer 1

Name

Address

Contact Number

Parent/Carer 2

Name

Address

Contact Number

More about you

Why would you like to study at the Brunts Academy?

Please tell us about your career plans or ideas:

Please tell us something about your personal interests and extra curricular activities:

Health – please specify any particular problems:

Individual needs (e.g. Dyslexia) please outline extra help/equipment required:

Sixth Form Preference(s)

Is Brunts your first choice?

If no, at present, what courses are of interest to you in other Sixth Forms / Colleges?

Exam Results and Predictions

(to be completed by external applicants only)

GCSE / Vocational Subject

Predicted / Actual grade (if known)

GCSE / Vocational Subject & Predicted / Actual grade (if known)