In Year Application Form

1. Student's Details

Student's Family Name/Surname(s)* Student's Given Name/First Name(s)* Student's Date of Birth* Student's Home Address including postcode* Student's Current School Year* Does the Student have sibling(s) living at the same address attending any PolyMAT Academy?* If Yes, please provide name, school, date of birth of sibling/s who already attend any PolyMAT Is the Student's parent/carer a member of staff at any PolyMAT Academy?* If Yes, please provide the name of the school and staff member name

2. Details of current/previous School

Full name of Student's current school/last school attended and full address (including postcode)* Start date* Last date of attendance* Reason for leaving current School* Previous School attended and full address (including postcode)* Start Date* Last date of attendance* Reason for leaving* Full Name and address of Primary School* Start date* End Date*

Has the student had any previous suspensions?*YesNo

If YES please provide number of suspensions and reason(s):

Has the student ever been excluded?*YesNo

If YES, please provide the reason:

Has the student been previously been educated abroad?*YesNo

If Yes please provide the name and full address of the School including country* Start date* End date* Date returned to UK* Have you notified the Students current School of your application?*

3. Parent/Carer Details - Primary Contact

Student lives with* Title* Family Name/Surname* Given Name/First Name* Parent/Carer Home Address including postcode* Daytime Telephone Number* Email Address* Relationship to Student*

Secondary Contact Details

Title* Family Name/Surname* Given name/First Name* Parent/Carer home address including postcode* Day time telephone number* Email Address* Relationship to Student*

Third Contact

Title* Family Name/Surname(s)* Given Name/First Name* Parent/Carer home address (including postcode)* Daytime telephone number* Relationship to Student*

4. Looked after children

Is the Student adopted?* Is the Student a child looked after or previously looked after and now adopted OR subject to a residence OR special guardianship order immediately following having been looked after?* If Yes, please provide the date the student went into care Borough of care for looked after child Does the Student have a private guardianship* Is the Student a young carer* Name of Social Worker Social Worker Telephone Number Social Worker Email Address

5. SEN, Medical or Social

Does the Student have a current EHCP?* Does the Student have any Special Educational Needs SEN?* If Yes, please provide more information

Was the Student on the record of need in their previous School (Primary or Secondary)*YesNo

Did the Student need help to settle into School? Did the Student previously have a mentor?* Has the Student previously received group support in School?* Has the Student had any assessment(s)?* Do you feel that there is an acute exceptional medical or social reason why your child should be offered a particular school?* Students Doctors Surgery*

6. Ethnic/Cultural Background

Student's Ethnicity Is the Student identified as EAL (English as an Alternative Language)* If Yes, how would you categorise their level Student's country of birth* If outside of the UK, please provide date of arrival in UK* Student's First Language* Students who are given a place at Woolwich Polytechnic School will be invited in for an interview and test, would you require an interpreter?* If Yes, please specify for what language Please state the religion of the student*

7. Additional Information

Has the Student been permanently excluded?* Is the Student currently being educated at home?* Are any of the Students Guardians in the Armed Forces?* You have no recourse to Public Funds*