11

Please do not complete this form directly from your web browser but instead, download and save it as a form.

Please note: If you are statemented, or have an EHCP, please apply directly through your local authority. Your application will be subject to the following criteria:

1. Meeting the academic entry requirements, as advertised onour website.

2. The Academy being consulted formally by the localauthority, that we are able to meet the student’s needs.

Sixth Form (Level 3) 2018/19

Application Form Co-Principal: Robin Street/ Simon McBride

The UCL Academy, Adelaide Road, London, NW3 3AQ T: 0207 449 3080

E: admissions@uclacademy.co.uk W: www.uclacademy.co.uk

Surname:First name(s): Current school:Date of Birth (01/09/2001)-31/08/2002)UPN:

ULN: UCI No:

Your UPN, ULN and UCI can be obtained from your school'sExaminations Officer. If you attend an independent school, you should be able to at least obtain your UCI number.

Please email your completed application form to admissions@uclacademy.co.uk, ensuring you include ‘Level 3 Application Form’ in the subject field.

Gender Female Male

12

Section 1: Student’s personal details

First Names:

Surname:

Date of Birth:

Gender:

Address:

Postcode:

Student’s Mobile No:

Home Telephone Number:

Student’s Email:

13

Section 2: Parent / Guardian’s contact details

Title: Ms/ Miss/ Mr

Parent/Guardian Forename:

Parent/Guardian Surname:

Relationship to student:

Email:

Address:

Post Code:

Home Telephone No

Mobile No:

Section 3: Choice of Courses

Please indicate your four preferred choices of courses below.

Refer to the Academy website and discuss your choice with your teachers and parents/guardians. Check with your school or careers advisors whether your prospective career/Higher Education route requires specific entry qualifications. Please ensure your choices are made with reference to the course synopses which can be found at the following link http://www.uclacademy.co.uk/Courses and see the entry requirements below.

Biology

Chemistry

Computer Science

Design Technology

Drama

Economics

English Literature

Fine Art

Further Mathematics

Minimum Entry Requirements

You must be able to offer at least six GCSE at Grades 5-9, including English and Mathematics with an overall average score of no less than 5.5, with a minimum of a grade 6 in the subjects you previously studied and wish to continue in the Academy.

Please note the additional minimum entry requirements for the following subjects:

Geography

German

Government & Politics

History

Mandarin

Mathematics

Music

Philosophy

Physics

Psychology

Sociology

Spanish

• Biology / Chemistry / Physics – 6 in the subject you wish to study. If you have not previously studied these subjects,you must achieve a 7 or above in Double Science / Core and Additional Science. You must also achieve a 7 in GCSEMathematics if you wish to study Physics• Computer Science – Grade 6 at GCSE in Mathematics• Drama - Grade 6 in GCSE English Literature. Please note, a preference will be given to those who also achieve a grade6 in GCSE Drama• Engineering - Grade 6 in both Core and Additional Science (equivalent to two GCSEs). Please note, a preference willbe given to those who also achieve a grade 6 in GCSE Design and Technology• English Literature – Grade 6 in GCSE English Literature• Fine Art - Grade 6 in GCSE Art and Design• Further Mathematics – Grade 8 or 9 in GCSE Mathematics• Geography - Grade 6 in GCSE Geography• History – Grade 6 in GCSE in History• Mandarin – Grade B in GCSE• Mathematics – Grade 7 in GCSE Mathematics• Music• – Grade 6 in GCSE Music or Grade 5 Theory and Grade 5 or above in your main instrument• Sociology – Grade 6 in any Humanities subject• Spanish – Grade 6 in GCSE Spanish

Physical Education

15

Section 4: External Examination Record

Subject/Course

(Indicate Higher, Intermediate, Foundation, etc if relevant)

GCSE

(Double, single or short)

Date

(Month/Year)

Estimated

grade if not taken

(E.g. ‘mocks’)

Final result

if taken

Date of final result if taken (Month/Year)

16

Section 5: Please list any other relevant current qualifications and grades obtained if applicable. Please note this does not include SATS results.

Subject/Course

(Indicate Higher, Intermediate, Foundation, etc if relevant)

Qualification Date

(Month/Year)

17

Section 6: Present School Details

What is the name of your current school?

Are you currently in Year 11?

Does your current school have a Sixth Form?

Yes

Yes

No

No

If you have left school, please give the name of the school and the date of leaving

If you have left school, please give the reasons for leaving your last school and explain what you have been doing since you have left

Do you have a sibling currently at the UCL Academy?

Yes No Name of sibling Year sibling currently enrolled in

18

Section 7: Equlity statement

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?

Wheelchair User

Hearing Impairment

Mental Health Issues

Speech Difficulty

Dyslexia

Dyscalculia

Other (Please specify below)

ADHD

Aspergers

Autism/Autistic Spectrum

English as an additional language(EAL/ESOL)

Visual Impairment

No

Medical condition which significantly affects daily life (Please specify

Have you received any SEN support at your current school? Yes

Have you been granted access arrangements for examinations? Yes No If yes, what arrangements do you

Scribe Word Processor Extra Time

Other please specify

Please Note: This information does not count against your application.

19

Section 8: Equal Opportunities Monitoring

Completion of this section will help us fulfil our general duty under the Race Relations (Amendment) Act 2000 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 for Education 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.

Asian or Asian British - Bangladeshi Mixed - White and Asian

Asian or Asian British - Indian Mixed - White and Black African

Asian or Asian British - Pakistani Mixed - White and Black Caribbean

Asian or Asian British - Other Asian Mixed - any other

Black or Black British - African White - British

Black or Black British - Caribbean White - Irish

Black or Black British - Other Black White - Other White

Chinese or Chinese British Other ethnic group

Prefer not to say

What do you consider to be your first language?

What is your home language?

What is your religion? No religion Prefer not to say

Section 9: Funding Eligibility

What is your nationality? (as stated on your passport)

Do you have a parent who is in the Armed Forces Yes No

Are you or have you ever been considered a previously Looked After Child? Yes No

Have you been permanently resident in the UK or EU for the past 3 years? Yes No*

*Please comment on final page of application if no.

Is there any restriction on the time you may stay in the UK?

*Please comment on final page of application if yes.

Yes* No

110

Section 10: Other Schools/Colleges applied to:

Many students apply to more than one place – their school sixth form, employment, two or more colleges etc. This will not affect whether you are offered a place at The UCL Academy or not, but helps us know your alternative plans so that we have sufficient places in September, for you and for others. Please list all the places applied to, including this Academy, in the order of your preference.

1.

2.

3.

4.

111

Section 11: Personal Statement

Please indicate your reasons for choosing The UCL Academy and your course or subjects (including careers you

have considered or are currently considering):

.

112

Any other information that you wish to give (including any additional information to Sections 2 or 4 of this form):

113

Section 12: Confirmation of application

Data Protection Act: The information that you have given in this form will be held on the Academy’s files, including computer files and may be used for statistical purposes within the Academy and may be shared with schools, local authorities and funding bodies. In signing this application you are giving your consent to us to use this data and share information on your progress with your parent/guardian.

Please confirm the following points below:

I confirm I have requested a completed reference request form from a member of staff at my current school. Please note, we will be unable to process any applications until a completed reference request form is received.

Yes Please tick

I understand that if I am offered a place at the Academy, it is conditional upon receiving the necessary grades:

Yes Please tick

I understand that if my application is successful, I must provide my valid passport /other official proof of identity, and my original examination results at the time of enrolment:

Yes Please tick

Signature of Applicant (please type signature)............................................................... Date .........................................

Support of Parent/Guardian

Have you discussed this application and the applicant’s proposed courses with your daughter/son/ward?

Yes Please tick

I support this application and will ensure that the Academy’s regulations will be followed:

Yes Please tick

Signature of Parent/Guardian (please type signature) ........................................................ Date ...............................

114

.

Important information

The Deadline for applications is Friday 26January 2018. Please note that the application deadline is subject to extension at The UCL Academy’s discretion.

References

Please ensure that your Head of Year completes a reference form which can be found at the following link http://www.uclacademy.co.uk/Level-3-Application-Form. Once they have completed it, they will need to save it as an attachment and email it directly to admissions@uclacademy.co.uk ensuring that they include ‘Level 3 Application Reference Form’ in the subject field.

Do not wait for your school to complete the reference form. They can send the reference form to us separately but we cannot process your application until the reference arrives.

Submission

Please email your completed application form to admissions@uclacademy.co.uk

Conditional Offers

All provisional enrolments are conditional on achieving specific grades at GCSE. Conditional offers will be confirmed in writing.

Students who do not achieve the required grades should inform the Academy when the results are received. It may not be possible to place you on an alternative course if you do not achieve your target grades.

Enrolment

Applicants must provide original documentary evidence of GCSE results and proof of identity during the enrolment process which will take place in August 2018. Failure to provide all this information willmean that we are unable to guarantee the confirmation of your offer.

How did you hear about Level 3 at The UCL Academy?

Current Level 3 Student

The UCL Academy Website

Social Media

Advertisement

Name of Student:

Word of mouth

Other