Blank GSA Salter Sixth Application Form Sept 2022 1
Blank GSA Salter Sixth Application Form Sept 2022 1
Blank GSA Salter Sixth Application Form Sept 2022 1
Davey Road
West Bromwich
West Midlands, B70 9UW
T: 0121 553 4665 Ext. 5233
PERSONAL DETAILS
Please read the guidance notes carefully and complete using black ink, writing clearly.
Surname: Forenames:
Gender: DoB (dd/mm/yyyy):
Your Mobile No: Parent/Carer
Mobile no:
Home address:
Postcode:
Your E-mail Parent/Carer
address: E-mail address:
Present school:
We will send you an e-mail confirming receipt of your application form and important information relating to admissions
events.
If you DO NOT wish to receive an e-mail acknowledgement or updates, please tick this box: ◻
EQUAL OPPORTUNITIES
Please note that the data gathered via our application paperwork is used, confidentially, to ensure all applications are treated fairly as
regards the Equality Act. The Learning Support information helps the Academy understand any specific needs, and hence determine
and make any reasonable adjustments required in advance of students attending for interview. All applicants are considered on the
basis of potential to benefit from a place at the Academy.
◻ Caribbean
◻ Other Black/African/Caribbean
Alternatively:
◻ Prefer not to say
All students: Do you have any learning support or other needs e.g. Dyslexia, Hearing, Visual or Mobility. Please tick box A
or B. If yes, please provide further details at the end of this document.
A. Yes ◻
B. No ◻◻
SUBJECT CHOICES
Please list FOUR subjects in the table below in order of preference. The first subject being the first choice. You will have the chance to
change your mind throughout the admissions process.
GCSE SUBJECTS
Subject Your grade prediction Teachers grade Grade if already achieved
prediction
English Language
English Literature
Mathematics Higher*
Mathematics Foundation*
Triple Award Science **
Double Award Science**
Applied Science**
Science – other**
2
* Enter details for EITHER Higher or Foundation Level Mathematics.
** Enter details for EITHER Triple Award Science, Double Award Science, Applied Science or
Other Science.
NOTES
PERSONAL STATEMENT
Please comment on your achievements in and out of school, what you can offer George Salter Sixth Form, and reasons for your choice
of subjects/courses together with your long term career plans.
3
REFERENCE
Please complete the name of your Head of Year, Head of House or Tutor.
Name: School:
Acknowledgement of
application:
APPLICATION PROCESS Date of meeting sent:
4
Date:
Interviewer:
Attendance: Present No-Show
Offered place: Y N
Destination: