Millbrook Academy Sixth Form Application Form Surname

Telephone

Forename(s)

Email

Date of birth

Parent/Carer Name

Student’s signature

Parent/Carer signature

Address

Postcode Present tutor group

Current School

Please list your chosen subjects, in order of preference, and state whether AS Level, Double AS or BTEC Level 3 Subject

Telephone 01452 863372

AS, Double AS, BTEC, other

Millbrook Academy email [email protected] www.millbrookacademy.org

Millbrook Academy Sixth Form Application Form Personal Statement Your reasons for wishing to join Millbrook Academy Sixth Form (attach a separate sheet if necessary)

The areas of responsibility in which you are interested

Extra-curricular interests

External applicants only This section should only be completed by students NOT currently attending Millbrook Academy. Please list in the table below the GCSE subjects you are currently studying and where available the predicted grades you are considered likely to achieve in your GCSE examinations. Subject

Prospective student signature

Estimated grade

Subject

Parent/Carer signature

Estimated grade