Sixth Form Application Form

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.