First Name: (required) Last Name: (required) Phone Number: (required) Your Email: (required) Date of Birth: Current Address: Name of Parent with Parental Responsibility: Name of Current School: (required) Address of Current School: (required) Name of Referee: (required) Predicted GCSE Grade for English Literature: (required) Predicted GCSE Grade for English Language: (required) Predicted GCSE Grade for Mathematics: (required) Please select the courses you would like to take: ArtBiologyBusinessChemistryComputer ScienceDanceEnglish Literature & LanguageFrenchGeographyHistoryMathematicsMusicPhysical EducationPhysicsProduct DesignReligious Studies Do you have a disability, learning disability or any medical condition? If yes please state below: YesNo Please state your disability, learning disability or medical condition below: Is HTA Sixth Form your first choice of place to study? Residency: I am a UK citizen or have been ordinarily resident in the UK and Islands for the full three-year period before the first day of the first academic year of the course, i.e. from 1 September 2015 to 31 August 2018 If neither of the above residency statements apply, please give details of your residency: All personal data will be processed in full compliance with the Data Protection Act 1998. Personal data will only be processed to support your application.