Y9 Application Form 2021 Entry

Parent / Carer Details
Parent / Carer's Name*
Title First Last
Relationship to Student
Home Address*
Same as Student
Street Address Address Line 2 City ZIP / Postal Code
Home Phone
Mobile
Email Address*
Enter Email Confirm Email

Declaration and signature of Parent / Carer
{all_fields}
- I confirm that I wish to apply for a place for my child at UTC Derby Pride Park.
- I certify that I am the person with parental responsibility for the child named above and 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- I understand that a place may be withdrawn if it is offered because of fraudulent or misleading information.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)
Name
This field is for validation purposes and should be left unchanged.

Applicant Details