PREFERENCE FORM



LATE TRANSFER TO JUNIOR SCHOOL,

SEPTEMBER 2021

COMMON APPLICATION FORM

RETURN by 5pm on 15th January, 2021 to:

CO-ORDINATED ADMISSIONS, SHIRE HALL, WESTGATE STREET, GLOUCESTER, GL1 2TP

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| |CHILD’S NAME |PERMANENT HOME ADDRESS |

|SURNAME | | |

| | | |

| | | |

| | | |

|FIRST NAMES | |If you are moving house, please give your new address and your moving date. You will|

| | |also need to provide proof of this new address. |

| | | |

| | | |

| | | |

| | | |

|MALE/FEMALE | | |

|DATE OF BIRTH | |DATE OF MOVE: |

|Is the child in public care or fostered |Y/N |If ‘Yes’, please give the name and phone number of the social worker below: |

|under an arrangement made by the local | | |

|authority? | |................................................................................ |

Please ensure these details are correct and that you are using your child’s current, permanent home address. If you are moving house and your child’s permanent home address changes, you must contact us at the time of your move and be able to provide proof of this new address in the form of the completion letter or long-term tenancy agreement.

Please be aware that if you move house after the closing date (15th January 2021) and/or we receive proof of your new address after this closing date, we will not be able to update your child’s address for allocation purposes and your child’s school allocation will be based on the address given above.

Preferred Junior School

You can list up to five junior schools below in preference order for your child. You can only name junior school preferences on this form. If you wish to be considered for a primary school place please contact the primary school directly.

If you live outside Gloucestershire and wish to apply for a school in this county, please contact your home Local Authority.

|Section 2 |Name of junior school |Reason for preference |

|1st preference | | |

|2nd preference | | |

|3rd preference | | |

|4th preference | | |

|5th preference | | |

If you are only considering a place for your child to attend a private or independent school, please tick the box and also name the school here…………………………………………………………………………………

It is your responsibility to contact any private or independent school to arrange admission.

Section 3 Details of Any Older Children You May Have

If you would like your child, named in Section 1 above, to be considered for the same school as an older brother or sister you must complete the details overleaf. Please see Admission to Primary School and Infant/Junior School Information Booklet for sibling definition. Sibling link does not guarantee a school place.

|Brother or Sister |Name of School |Sibling’s Date of Birth |Year Group Now |

|(full name) | | | |

| | | | |

|Address of brother or sister |

| |

Additional Information

Does your child have a Statement of Special Educational Needs/ECH Plan Yes No

Does your child have a medical, physical or psychological reason Yes No

why it is essential that they attend one of your preferred schools?

(Please refer to the Infant, Primary & Junior Schools Information booklet –

if the school has a medical category within the criteria please contact the school directly)

Have you selected any of these schools on the basis of faith? Yes No

If you answer ‘yes’ you may need to provide additional information

to the school to clarify your faith or your child’s faith.

Please contact the school directly and state which faith here…………………………………………...

Do you wish for an email to be sent confirming that we have received your form? Yes No

Notes:

You should read the School/Academy Admissions Guidance Booklet and Information Booklet before submitting your application form which is available online at .uk/schooladmissions

Late applications will not be considered until after notification day of the 16th April 2021. Therefore it is essential you return your form or apply on-line before the closing date of 15th January 2021.

Please ensure the details are correct and it is your child’s permanent home address, NOT the address of a business, a relative, a friend, a childminder, a temporary address or an address to which you hope to move.

Full information on transport policy for primary aged children can be found on line in the School Admissions Guidance Booklet.

If you have any questions please contact Co-ordinated Admissions

( 01452 425407 ( school.admissions@.uk

| |

|I confirm that I have parental responsibility for the child I am applying for. |

|I have read, and understand, the information contained in the School Admissions Guidance booklet. |

|I declare that the information contained in this application is true and I am aware that failure to provide accurate information may result in the child’s offer|

|or placement being withdrawn in accordance with paragraphs 2.12 and 2.13 of the Schools Admissions Code and also s 84 of the School Standards & Frameworks Act |

|1998. |

| |

|Parent/Carer Name……………………………………………………………………………………Mr/Mrs/Miss/Ms |

| |

|Relationship to child……………………………………………………………………...... |

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|SIGNATURE:________________________________________________Date:____/___/________ |

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|Contact details: Home telephone number………………………………………Mobile number………………………………… |

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|Email address:…………………………………………………………………………………………………. |

Data Protection Act. Any personal information you give us is held securely and will be used only for the purposes outlined in the privacy notice. In accordance with the General Data Protection Regulation (GDPR) and Data Protection Act 2018 we must inform you of how we use this information for the purposes of School Admissions, in line with our responsibilities. For further information on how we use this information please view our Privacy Notice which can be found online at .uk/privacynotice

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