Y12 Application Form 2022 Entry

To apply for a post-16 student place, please complete this online application form.

1Applicant Details

2Education Details

3Personal Statement

4Qualifications

5Confirmation

Applicant Details
Applicant's Name*
First Middle Last
Date of Birth*
Day
Month
Year
Gender*
Current Home Address*
Street Address Address Line 2 City Postcode
Personal Email Address*
Home Phone Number
Are you, or have you previously been looked after by a Local Authority?*
- Yes
- No
Which Local Authority?*
Name of Social Worker*
Residency
If you are NOT a national of the European Economic area (including the UK) you should note the following:
Students of all nationalities permanently resident in the UK are entitled to state education and so are eligible to apply for this school.
The following are not entitled to a state education:
- Nationals of countries outside the European Economic Area (EEA) who are here as short-term visitors - these are students who live abroad but have been admitted to the UK for a short visit (for example as tourists or to visit relatives), and not to study
- Nationals of countries outside the European Economic Area (EEA) who have permission to enter the UK to study - these students are allowed to study in England on the basis that they attend an independent school or FE college with tier 4 sponsor status. These institutions are listed on at: https://www.gov.uk/government/publications/register-of-licensed-sponsors-students

What Would You Like To Study?
If you are not sure which course you wish to study, please discuss your career options with a Career Adviser in school or college. You can also contact the National Careers Service on: 0800 100 900 or through their website: https://nationalcareersservice.direct.gov.uk
We will be holding open events throughout the year for applicants to take a tour of the facilities, check our website for details https://www.utcderby.org.uk/events
What area are you interested in?*
- Engineering
- Health & Life Sciences
More About You
What career are you aiming for?*
What are your interests and skills?*
Explain why you are applying to do follow the chosen specialism and the A levels you have selected and why you want to come to the UTC:*

Qualifications
If you are still at school/college, this question should ideally be completed by the appropriate school/college tutor. Alternatively, you could complete it yourself and ask your school/college tutor to check it.

If you have left school, or are not in school for whatever reason but are applying for a 16-18 place at UTC Derby Pride Park, please complete this section yourself.

Please list all the qualifications you have or are working towards.
GCSEs
Please complete the below as completely as possible, including all the GCSE qualifications you have or are working towards. For vocational qualifications (e.g. NVQ, BTEC, OCR) please complete the next question.

You can add more subjects by using the button to the right of each row.
GCSE Subject Date of Exam Grade (estimated or actual)
Vocational Qualifications
Please complete the below as completely as possible, including all the vocational qualifications you have or are working towards.

You can add more subjects by using the button to the right of each row.
Qualification (e.g NVQ, BTEC, OCR) Level Date of Exam Grade (estimated or actual)

Declaration and signature of applicant
{all_fields}
- I confirm that I wish to apply for a place at UTC Derby Pride Park.
- I certify that the information given is true to the best of my knowledge and belief.
- I understand that a place may be withdrawn if it is offered because of fraudulent or misleading information.
- I give permission for the information I have provided in this application form to be securely held, processed and shared for school admissions purposes, in accordance with Education Regulations and the requirements of the Data Protection Act 1998.
Confirmation of Agreement*
- I confirm that I agree to all the above statements.
Information for Learner Manager
Please enter if you know the following numbers:
CCIS ID
Unique Pupil Number (UPN)
Unique Learner Number (ULN)
Phone
This field is for validation purposes and should be left unchanged.

Qualification (e.g NVQ, BTEC, OCR)	Level	Date of Exam	Grade (estimated or actual)

Applicant Details