OFFICIAL USE ONLY Interview Details

Date and Time

Venue

Interviewer

ADMISSION NO.

Please complete in BLOCK capitals using a ballpoint pen Please note: Applicants for Year 12 entry must apply online via UCASprogress.com If you need help with completing the form, please contact us on 01223 712300 1 Student Surname

Student Forename(s)

2 Date Of Birth D

M

Age (on 31 August of proposed year of entry)………………………..

Y

3 Home Address

Postcode

Home Tel

Student Mobile

Student Email Parent Name Parent Mobile Parent Email 4 Education Details – schools / colleges attended from ages 11 to 16 (and since if applicable) School / College Name

5 Have you had any individual guidance to discuss your study choice?

From

Yes

To

No

6 Please tell us why Cambridge Academy for Science and Technology would be best suited for you and your education and a little about your aspirations for your academic and career path

7 Which course are you hoping to follow? Please tick one and list all of your predicted grades if applicable 

Year 9 Foundation Studies



Year 10 GCSE Studies



Year 12 Academic Pathway – A Level Studies

Predicted Grades (list all)



Year 12 Technical Pathway – BTEC Studies

Predicted Grades (list all)

8 Please tick the box if you are in care, or are a carer yourself (please see Guidance Notes) In Care

Carer

9 Resident Status Usual country of residence

Are you settled in the UK or have been ordinarily a resident in the UK and islands (that is including the Channel Islands and the Isle of Man) for the past 3 years?

Nationality

Yes

No

If NO, give date of entry to the EEA:

10 Have you ever been excluded from a previous school? If yes, please supply details

11 Equal Opportunities Monitoring To help CAM-AST monitor its Equal Opportunities policy, please tick the box that best describes your ethnic origin. White    

23. White English/Welsh/Scottish/Northern Irish/British 24. White Irish 33. White Gypsy or Irish Traveller 25. Any other White Background

Mixed/Multiple Ethnic Group  21. White and Black Caribbean  20. White and Black African  19. White and Asian  22. Any other Mixed/Multiple Ethnic background

Asian/Asian British  12. Indian  13. Pakistani  11. Bangladeshi  18. Chinese  14. Any other Asian background Black/African/Caribbean/Black British  15. African  16. Caribbean  17. Any other Black/African/Caribbean background

Other Ethnic Group  47. Arab  98. Any other ethnic background  99. Not provided

12 Additional Support Details We want you to get the best from your course so please let us know how we can support you. If you have any learning support needs, disabilities or medical conditions, we can contact you in confidence to discuss the support available. Please indicate below what support needs you have:  Visual Impairment  Hearing Impairment  Disability Affecting Mobility  Emotional/Behavioural Difficulties  Mental Health Difficulties  Moderate Learning Difficulty  Severe Learning Difficulty  Specific Language Impairment  Dyslexia  Dyscalculia  Autism Spectrum Condition/Aspergers Syndrome  Other: Signature of applicant

Date

Proposed Year of Entry September 20 STATEMENT BY PARENT/CARER

*Please provide information as required

This application has my support. Parent/Carer Signature* Please print name in block capitals* Address (if different from that of applicant)*

Postcode Please return completed form and reference to: Admissions Team, Coleridge Community College, Radegund Road, Cambridge, CB1 3RJ or via email to [email protected]

Guidance Notes Year 10 and Year 12 Applications Cambridge Academy for Science and Technology is fully committed to equalising opportunities and welcomes enrolments from everyone, irrespective of background, gender, disability or support needs. We are committed to safeguarding our students, staff and visitors by providing a safe environment and safe working practices. If you need any advice on which study option is best for you or if you need help with applying, please contact us on 01223 712300. This form is for year 10 entry and for late year 12 applications (i.e after closing date for applications via www.progress.com). 1. Please complete the application in block capitals using a ball point pen, preferably black. If you need any help completing your form, please contact us on 01223 712300. 2. Please enter date of birth and your age on 31 August at proposed date of entry. 3. Home address - If you have a different address for correspondence, please write it on a separate sheet and attach it to the form. If you change address after you have made an application, please inform us so your details can be updated. Please ensure you fill out parent name. 4. 11-16 Education details - Please complete if you are in full-time education or have just left, indicating current/ most recent school/college. 5. It is important that you discuss your course choice and future career direction. If required, we can arrange for you to attend an individual interview with a Careers Adviser. 6. Please tell us why you are considering learning at Cambridge Academy for Science and Technology and additional information about yourself, e.g. work experience, interests, skills and other achievements, and why you wish to come to the college. Applicants who have not recently completed full-time education in school or college please include education/training details in this personal statement.

7. To help ensure that you meet the right staff members at interview it is useful to have an idea of the course you hope to study. Please also ensure that you list all of your predicted grades should you be applying for a Year 12 Pathway. 8. We are aware that young people who have been in care, or are carers themselves, move schools more frequently than others or have often missed chunks of schooling through actual absence or as a result of disruption to their lives. If we are aware that you are living on your own or with foster parents, or are caring for someone in your family, we will aim to provide you with additional support and opportunities to catch up with your work. Your circumstances will be treated confidentially and only shared with your permission with those staff who need to know. 9. Please complete your resident status. 10. Students who have exclusions will be referred to the head of learner services for assessment. 11. This section invites you to describe your ethnic origin. It helps us to monitor our Equal Opportunities policy and is treated in strict confidence. However, if you do not wish to provide this information there is no obligation to do so. 12. Please tick the relevant additional support boxes if you feel you would benefit from learning or other specialist support.

Date you submitted your application __________

Please keep this page for reference Cambridge Academy for Science and Technology, Robinson Way, Cambridge, CB2 0SZ Tel: 01223 712300 Web: www.parksidefederation.org.uk