1. Application for September 2019
Moseley Sixth Form
Application for September 2019
(current Year 11 or 12)
PERSONAL DETAILS
Surname
Forename
Gender
Male Female
Date of Birth
Address
Home Phone Number
Mobile Number
Parent(s) Name
Current School and Year group
Date Started
If Moseley, state house
Form
What type of courses are you interested in?
GCSE & Level 2 courses
BTEC National (Level 3)
A Level
Combination of BTEC National & A Level
Which subjects would you like to study?
Do you have a learning difficulty/disability and/or health problem(s)? Yes □ No □
If YES give details: ………………………………
Is the above likely to affect your learning?                          Yes □ No □
Do you have any support at school to assist you in your learning?            Yes □ No □
Do you have any evidence that you had extra support in your exams?     Yes □ No □
If you think that you qualify for support in your exams, we will need to see the written evidence from your present/previous school
Moseley School, Wake Green Road, B13 9UU • •

2. Level: GCSE / BTEC / Other Grade Estimated Grade Achieved
What subjects are you currently studying? Please include any GCSEs already achieved.
Subject & Exam Board
Level: GCSE / BTEC / Other
Grade Estimated
Grade Achieved
What are your career ambitions for the future?
How does your choice of subjects link in with this?
Moseley School, Wake Green Road, B13 9UU • •

3. Give details about any work experience you have had
Describe your interests and hobbies
Explain why you would like to study at Moseley School Sixth Form
Moseley School, Wake Green Road, B13 9UU • •

4. The student below has applied to us for a place in Sixth Form and has indicated that you are willing to supply a reference. Moseley School would like to take the opportunity to thank you for your assistance.
Current School
Name of Referee
Position
Date
Surname
Forename
DOB
Please confirm the dates between which the student attended the school/college
Start Date
Leave Date
Attendance
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Punctuality
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Attitude to Study
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Determination
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Maturity
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Aptitude for Advanced Level Study
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Moseley School, Wake Green Road, B13 9UU • •

5. Suitability for Chosen Courses
Excellent
Good
Satisfactory
Below Expectation
Poor
Very Poor ☐
Other information (for example, health, specific learning difficulties, requirements for exams)
Thank you for providing a reference for this applicant. Please return this form by to The information on this form will be held by us under the terms of the Data Protection Act and used for managing the application process, planning our provision and monitoring equality of opportunity for all of our applicants.
Moseley School, Wake Green Road, B13 9UU • •