HAB6 Online Application Form

If you have any queries regarding the completion of this form please telephone the Academy on: 0207 237 9316

Or, contact Ms Harris, Head of Sixth Form: Lyndsay.harris@harrisbermondsey.org.uk

Please note candidates who are currently not students at Harris Academy Bermondsey will be required to bring a passport sized photograph and a copy of your birth certificate or latest passport if invited to interview. If you already attend Harris Academy Bermondsey you are not required to submit the identity documentation.

Personal Details

Surname ^*

Other Names

Date of Birth ^*

Gender ^*

Address ^*

Postcode ^*

Home Telephone ^*

Student Mobile ^*

Student Email ^*

Parent/Carer Name(s) ^*

Parent/Carer Mobile

Parent/Carer Email

Personal Details

Do you have a statement of Special Educational Needs? ^*

If yes please provide date of statement.

Do you have any Special Educational Needs? ^*

If yes please provide more info.

Do you have a disability and/or require support at an interview? ^*

If yes please provide more info.

Do you have any underlying health conditions? ^*

If yes please provide more info.

Doctors name ^*

Doctors Phone ^*

Doctors Address

Current Education

Name of Current School ^*

Unique Pupil Number

Address of Current School ^*

Please supply the name of a teacher/head of year/house/faculty from whom we may request a reference regarding your choice of course.

Name ^*

Position ^*

Email Address ^*

Current Programme of Study

We will check the predicted grades when we request your reference

Subject	Qualification	Expected Grade

If more space is required, please enter details below

Personal Statement

In no more than 250 words, please explain the reasons for choosing these courses. Include your ideas for future careers and any other information you think may be useful such as interests and hobbies.

Faculty Prize

If you would like to apply for one of the Faculty Prizes please tick the prize you are applying for and complete the application below.

Arts Faculty Prize
Science, Mathematics and Engineering Research Prize

In no more than 300 words, please provide details of three of your achievements qualities or experiences that show best why you should win the Faculty Prize. You must only choose three and write in detail why you have chosen each one.

Course Choice

In up to four blocks you must select a 1st Choice and a 2nd Choice Option.

To be considered a full time student you must choose at least 3 A-Level subjects. The Business BTEC is an Extended Diploma so you will need to select that option in each block it is present. You may choose another A-Level alongside if you so wish.

Block A ^*

Block A 2nd choice

Block B ^*

Block B 2nd choice

Block C ^*

Block C 2nd choice

Block D ^*

Block D 2nd choice

Block E ^*

Block E 2nd choice

Please list any other subjects you wish to study in the box below

If you would like to apply for Further Mathematics A Level please tick this box
If you would like to apply for Further Music A Level please tick this box

Subject enrichment classes

Please indicate from 1-3 the projects that most interest you

1 ^*

2 ^*

3 ^*

Summer Expedition

Please indicate the summer expedition that most interests you

Arts Expedition
STEM Expedition

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Haringey

Merton

Newham

Southwark

Sutton

Thurrock

Wandsworth

Westminster

HAB6 Online Application Form

Please supply the name of a teacher/head of year/house/faculty from whom we may request a reference regarding your choice of course.

Current Programme of Study

Personal Statement

Subject enrichment classes

Summer Expedition

Sixth Form

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