Whitburn

Student Details

Legal Name*

Legal Forename Middle Name(s) Legal Surname

Chosen Name(s) (If different from above)

Forename Middle Name(s) Surname

Gender*

Male
Female

Date of Birth*

Will you be aged 17 or over on the 31st August 2025?*

No
Yes

I understand that if am aged 17 or over on the 31st August 2025 I will need to contact the Sixth Form in order for this application to be progressed.

Tick to agree

Address*

Address Line 1 Address Line 2 Address Line 3 Postcode

Home Telephone*

Student Mobile Telephone*

Student Email - this must be current & checked regularly (Please use a personal email address and not a school email address)*

Enter Email Confirm Email

First Language if not English.

School you are currently attending*

Whitburn Church of England Academy

If other, please state.

Name(s) of sibling(s) who currently attend Whitburn Church of England Academy

Children who have a sibling link and are residing at the same address (brother or sister including adoptive siblings, half siblings, step siblings, and long term fostered children) attending the Academy during the academic year of intended admission to Sixth Form. See note 2 on the Admissions Policy.

Are you currently a Looked after Child or have you ever been in the care of the Local Authority? (See Note 1 on Admissions Policy)*

Are you registered disabled?*

If yes to above, please give details.

Do you have any health conditions or a medical plan?*

If yes to above, please give details.

Do you require any extra support to help with these health conditions?

If yes to above, please give details.

Do you have any additional educational requirements? e.g. SEND or additional support with exams*

If yes to above, please give details.

Do you have a current Educational Health Care Plan (EHCP)?*

Whitburn C of E Academy Sixth Form is my first choice for Post-16 provision*

Yes
No

Parent / Carer Details

Did any of your parents / carers go to university or have a Higher Education qualification?*

Yes
No

Name*

Title Forename Surname

Relationship to Student*

Address*

Address Line 1 Address Line 2 Address Line 3 Postcode

Home Telephone*

Parent / Carer Mobile*

Parent / Carer Email*

Enter Email Confirm Email

Completing your Application Form

Details of the specific entry requirements and courses offered are available in the Sixth Form Prospectus which may be obtained via the website at https://www.whitburncofeacademy.org/sixth-form/prospectus.html

Please describe below any particular career aspirations at this stage, including whether you intend to move onto Higher Education.*

What hobbies and interests do you have within or outside of school?*

What extra-curricular or enrichment areas would you most like to explore at Sixth Form and why?*

Subject Choices

Students at Whitburn Sixth Form study three A Level or BTEC courses in common with the majority of Sixth Form providers nationwide. Universities are clear that a fourth subject is no longer an advantage and they would rather see depth of knowledge. To this end, students may choose to complete an Extended Project Qualification (the ‘EPQ’) alongside their three A-Levels. They may also choose to study Further Maths to complement their A Level Maths or Core Maths to back up their studies in Science subjects. In exceptional circumstances, students opting for Further Maths may choose to study three other A Levels. Speak to a member of staff at your guidance meeting for further advice.

Please read this additional guidance

Further Maths A-level may only be studied alongside Maths.

First Choice Subject*

Second Choice Subject*

Third Choice Subject*

Fourth Choice Subject (see above)*

Please can you also indicate if you would be interested in taking the following qualifications:

Core Maths
EPQ

Predicted GCSE Grades or a copy of last report

This section should only to be completed by applicants who attend schools other than Whitburn Church of England Academy.

Please detail below the grades you are expected (and/or have already) achieved.

Subject	Expected Grade	Foundation/Higher	Short/Single/Double Award

Upload Report

Max. file size: 16 MB.

Declarations and Agreements

Declaration:*

Tick to agree

I understand that the combination of subjects I have listed may not be possible owing to staffing and timetabling constraints, in which case I will be given the chance to amend my choices. I understand that if I join the Sixth Form I shall be expected to conform to the dress regulations, act in a responsible and mature way and demonstrate commitment to my studies and life within the Sixth Form. I will also act in a way that respects the Christian values and ethos of the Academy. I understand that if I am offered a Sixth Form place, it will be a conditional offer which requires me to meet all of the entry criteria both for Sixth Form entry and for individual subjects. Please see prospectus for details of entry criteria.

Signed*

Forename Surname

Date*

Your Agreement

By accepting a place at the Sixth Form you must agree to co-operate with the guidelines as stated in the prospectus and the student learning agreement, a copy of which can be found on the website. You will be encouraged to attend Taster Days, details of which will be sent to you via email.

Data Protection Act 1998*

Tick to agree

I agree to the Sixth Form processing personal data contained in this form or other data which the Academy may obtain from me or other people, whilst I am a student. I agree to the processing of such data for any purposes connected with my studies or my health and safety whilst on the premises or for any other legitimate reason. Information you provide on this application form will be passed to the Learning and Skills Council, which is registered under the Data Protection Act 1998. The registration is primarily for the collection and analysis of statistical data but also allows the LSC to share information with other organisations for the purposes of detecting fraud. Further information about data confidentiality is available on request from the institution at which you are enrolling. I understand that if I am offered a Sixth Form place, it will be a conditional offer which requires me to meet all of the entry criteria both for Sixth Form entry and for individual subjects. Please see prospectus for details of entry criteria.

Signed*

Forename Surname

Date*

Policy Agreements

Please read the relevant policies and sign. Please ensure you have familiarised yourself with the content of the following policies, procedures and documents which are available to view on the Sixth Form section of the Academy website.

Name of student:*

Name of person signing:*

Relationship to student:*

Consent for Educational Visits taking place during the School Day*

Tick to agree

Please read this carefully. Only once it has been signed and returned will students be allowed to partake in activities, visits, trips and extra-curricular activities. I give permission for my child to take part in visits, events and activities during the school day, and sporting activities during and outside of the school day. I understand that students will, on occasion be asked to make their own way to an event. I agree to notify the Sixth Form of any medical information and medications required whilst the student is taking part in the event.

Student Guidelines for the use of Academy Information Communication Technology*

Parent / Guardian agrees
Student agrees

Please read this document carefully. Only once it has been signed and returned access to the school network and the Internet will be permitted. If you violate these provisions, appropriate action will be taken by the school in line with existing policy regarding school behaviour. For serious violations, exclusion may be imposed. Where appropriate, police may be involved or other legal action taken. I have read and understand the above and agree to use the school computer facilities within these guidelines.

(Student) Bring Your Own Device (BYOD)*

Parent / Guardian agrees
Student agrees

Please read this document carefully. Agreeing to this is a requirement prior to the use of personal ICT devices within the Academy. If you violate these provisions, appropriate action will be taken by the Academy in line with existing policy regarding academy behaviour. For serious violations, exclusion may be imposed. Where appropriate, police may be involved or other legal action taken. I have read and understand the above and agree to use personal ICT devices within these guidelines:

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Whitburn Church of England Academy

Sixth Form Application Form

Sixth Form Application For Entry In September 2025

Student Details

Parent / Carer Details

Completing your Application Form

Subject Choices

Please read this additional guidance

Predicted GCSE Grades or a copy of last report

Declarations and Agreements

Your Agreement

Policy Agreements

Whitburn Church of England Academy

Related pages

Sixth Form Application Form

Sixth Form Application For Entry In September 2025

Student Details

Parent / Carer Details

Completing your Application Form

Subject Choices

Please read this additional guidance

Predicted GCSE Grades or a copy of last report

Declarations and Agreements

Your Agreement

Policy Agreements

Related pages