Application Form

About the student

First Name*:
Surname*:
Gender*:MaleFemale
Date of Birth*:
Year Group at School*:
Address*:
Email Address*:
Mobile No*:
School Currently
Attended:
When did you join
your current school*?

About the parent or guardian

First Name*:
Surname*:
Relationship
to Student*:
Address:
(if different to address above)
Email Address*:
Tel contact (daytime)*:
Tel contact (evening):
(if different)
How did you hear
about the course?*:

Dates student can attend

Week 1: 6th April – 10th AprilWeek 2: 13th April – 17th AprilOther
If 'Other' was selected above, please provide alternative days/dates

Subject Information

Please ensure that you fill in all detail requested for each subject for which you wish to apply for revision support. If you do not have information on exam board etc. your subject teacher, Head of Year or your school’s examination officer will be able to assist you.

SUBJECT ONE
Subject One:
Level: GCSEASA2Other
Exam Board:
Course Code:
Optional Papers:
(Please give names and codes)
Specific areas of the syllabus/specification where you would like support?

Do you have any particular worries or weaknesses in the subject - these could relate to topic areas mentioned above, or to technique – writing essays, solving problems, answering the question, using time well in mock exams etc.

SUBJECT TWO
Subject Two:
Level: GCSEASA2Other
Exam Board:
Course Code:
Optional Papers:
(Please give names and codes)
Specific areas of the syllabus/specification where you would like support?

Do you have any particular worries or weaknesses in the subject - these could relate to topic areas mentioned above, or to technique – writing essays, solving problems, answering the question, using time well in mock exams etc.

SUBJECT THREE
Subject Three:
Level: GCSEASA2Other
Exam Board:
Course Code:
Optional Papers:
(Please give names and codes)
Specific areas of the syllabus/specification where you would like support?

Do you have any particular worries or weaknesses in the subject - these could relate to topic areas mentioned above, or to technique – writing essays, solving problems, answering the question, using time well in mock exams etc.

SUBJECT FOUR
Subject Four:
Level: GCSEASA2Other
Exam Board:
Course Code:
Optional Papers:
(Please give names and codes)
Specific areas of the syllabus/specification where you would like support?

Do you have any particular worries or weaknesses in the subject - these could relate to topic areas mentioned above, or to technique – writing essays, solving problems, answering the question, using time well in mock exams etc.

Learning Disabilities

If you have any form of learning disability for which you have been assessed and for which you might have been allotted extra time or some other form of support in the exam room, please give details below:

Do you require accommodation? (Accommodation is full-board)* YESNO
Do you have any special dietary requirements?* YESNO
If YES Please give details below:

Do you have any allergy or medical condition of which we should be aware?* YESNO
If YES Please give details below:

Finally, is there anything else you would like us to know about you, that will help us to assist you during your time with us?