Surname * Forename(s) * Date of birth * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Gender * - Select -FemaleMale Nationality * - Select -AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCaribbean NetherlandsCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong Kong S.A.R., ChinaHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluU.S. Virgin IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabwe Ethnicity * - Select -ArabAsian or Asian British – IndianAsian or Asian British – PakistaniAsian or Asian British – BangladeshiAsian or Asian British – any other Asian backgroundBlack or Black British – CaribbeanBlack or Black British – AfricanBlack or Black British – any other Black backgroundChineseMixed – White and Black CaribbeanMixed – White and Black AfricanMixed – White and AsianMixed – Any other mixed backgroundWhite – BritishWhite – IrishWhite – any other White backgroundAny other ethnic origin group UK Residency * - Select -YesNo Home address * Home telephone number * Mobile number E-mail Present school * Tutor group * Estimated / Achieved grades SubjectLevelEstimated / Achieved GradeYear taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken Subject Level Estimated / Achieved Grade Year taken What are your present career plans (if undecided, say so)? Please state whether you have any learning needs, disabilities or medical conditions for which you will require additional support. Please state whether you receive additional support in the classroom or for examinations. Please contact Chris Howard on 01328 857012 or email firstname.lastname@example.org if you require assistance in completing this form. Please sign the declaration below and then turn over to enter your subject choices. I wish to apply for the courses indicated overleaf and acknowledge that Fakenham College reserves the right to alter or withdraw any course as deemed necessary. Signature of applicant * Countersigned by Parent/Carer * Date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20152016201720182019 Every applicant will have an interview with a member of College Management to answer any questions that may arise from the completion of this form and establish the most appropriate course of study. As a general guide: If you are estimated to achieve fewer than 5 GCSEs at A* to C (or equivalent) you should apply for Level 2 course (taken in one year). Successful completion may lead to progression to Level 3 courses. If you are estimated to achieve 5 GCSEs (or equivalent) at level ‘C’ and above (including English or Mathematics) you should apply for Level 3 courses (2 year ‘Advanced’ Level study). Level 2 OptionsFakenham College offers students who do not achieve 5 GCSEs at grade C (or equivalent) or above, the opportunity to enrol on a one year course to resit English and Maths GCSEs, complete qualifications in workskills and gain valuable work experience. Please tick this option if interested Yes I am interested Level 3 Options (Advanced Level) The courses offered below constitute the College’s proposed curriculum for 2017. However, the College reserves the right to alter the offer if necessary. You should choose 4 subjects —where possible one from each column If you have preferred subjects in the same column, please list in box marked ’Subject Clashes’ Please number your choices in order of preference. Option block A Option A options * English Literature Extended Project Film Studies Mathematics Physics Sociology English GCSE Maths GCSE None of the above Option block B Option B options * Chemistry Drama Extended Project History Photography Psychology None of the above Option block C Option C options * Art Extended Project Health & Social Care ICT Mathematics Philosophy & Ethics Psychology Spanish None of the above Option block D Option D options * Biology Business English Language Extended Project French Textiles None of the above Option block E Option E options * Extended Project Further Maths Geography Media Studies Music Sport Studies None of the above Subject Clashes If you have preferred subjects in the same column, please list them here.