Loughborough Amherst School Sixth Form for International Pupils This form is for Loughborough Amherst Sixth Form International Pupils applications. Please note, a non-refundable registration fee is required when filling out this form. Please complete and submit the form below. Fields marked * are mandatory. If you wish to apply for more than one candidate please complete the form again. If you have any questions, please call us on +44 (0) 1509 638280 or email amherst.admissions@lsf.orgCandidate's DetailsLegal Surname* Legal Forename(s)* Preferred Forename/Known As Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender Boy Girl Religion*Enter the child's religion Nationality* Is English the candidates first language* Yes No First Language* Please note any previous experience in learning a Modern Foreign Language as well as how many years your child has studied each language.English Language – Level of AttainmentIELTS TRF Certification No. CEFR Other School YearYear of Entry* Current Year Group (If applicable) Names of close relatives at, or having attended, Loughborough Schools Foundation, their relationship to candidate and School attended.Additional CommentsEnter any additional comments you wish to make herePassport DetailsPassport Number* Passport Expiry Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20332032203120302029202820272026202520242023Country of Birth* Place of Birth* A copy of the passport and birth certificate must be supplied when submitting this form.Copy of Passport*Max. file size: 12 MB.Copy of Birth Certificate*Max. file size: 12 MB.Current SchoolName of current School* Name of Head* Address of School* Street Address Address Line 2 City County / State / Region ZIP / Postal Code Email Address of School* Date joined current School*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Amherst would like to contact your child's current school for a reference. Please indicate by ticking one of the boxes below, if you give consent to this.* Yes No Parent/Legal Guardian DetailsParent Legal/Guardian 1Title* Forename(s)* Surname* Relationship to candidate* Address* Street Address Address Line 2 City County Postcode Home Phone*Mobile PhoneEmail Address* Occupation* Employer* Add additional parent/legal guardian? Yes Parent Legal/Guardian 2Title* Forename(s)* Surname* Relationship to candidate* Is your address the same as above? Yes Address* Street Address Address Line 2 City County Postcode Home Phone*Mobile PhoneEmail Address* Occupation* Employer* Where parents have separated or divorced, please state with which parent the candidate resides. Are you using an Agent to handle your application? Yes No Name of Agency Do you require Child Student sponsorship? Yes No Please give details of the Visa that the student will be travelling on Loughborough Amherst School recommends students take three subjects to A Level. In addition, physical education and enrichment activities form part of the curriculum for all Sixth Form students. To view the latest Sixth Form option choices booklet, follow the link on the Sixth Form page of the www.lsf.org/amherst website.Proposed A Level subjects* Reserve subject choice* Predicted GradesPlease list grades for any GCSE exams or equivalent already taken and predicted grades for those to be taken.Date taken/to be takenQualification (e.g. GCSE)BoardSubjectGrade/predicted grade Personal StatementThe student should use the space below to write a short statement about themselves describing, for example, involvement in extra-curricular activities both in and outside school.Medical detailsPlease provide details of any medication your child requires, disability, medical condition or allergies your child has, or may have, of which the School should be made aware.Learning Support / SEN needsPlease provide details of any learning support / SEN needs e.g dyslexia, dyspraxia, ADD, ADHD, Autistic spectrum disorder (including Asperger's Syndrome) or if your child is being assessed for any of these conditions.If you wish to attach any supporting reports/documentation you may do so here.For example an educational psychologist's report, medical report, occupational therapist's report, please give brief details on a separate sheet and attach a copy of the most recent report. Drop files here or Select files Accepted file types: jpg, png, doc, docx, Max. file size: 12 MB. Exam Access ArrangementsA candidate who is eligible may be given appropriate adjustment in relation to entrance assessments, subject to documentary evidence being provided. Therefore, if the candidate has had a specialist assessment diagnosing a learning difficulty or disability, for example an educational psychologist’s report, medical report, occupational therapist’s report, please provide details in the boxes above and attach a copy of the most recent report. If the candidate suffers from any medical condition or physical incapacity of which we should be aware, please provide details in the Medical Details box above.Please indicate here if you wish to discuss further. Yes ScholarshipsAll candidates are automatically entered for an academic scholarship. Applications for music scholarships should be made directly to the Music School. Further details, including the deadline for applications, are available here. Music Scholarship auditions are held around the time of the academic entrance examination. Applying for a Music Scholarship I would like to apply for a Music Scholarship Further DetailsPlease use this space to provide further details relating to any question or other matter about which you feel we should be aware.Registration and Examination Fee: £130 per candidate.Payment options: Payment can be made either by Bank Transfer using the details below, by Cheque (payable to Loughborough Schools Foundation) or click to pay by Credit Card: Loughborough Schools Foundation Current a/c no. 08171610Sort Code 60 14 10IBAN: GB86 NWBK 6014 1008 1716 10SWIFT CODE: NWBK GB 2LReference: ASRF and candidate’s surnameI have made payment by: Bank Transfer Cheque Credit Card Date payment was sent / madeDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Data ProtectionI understand that information from this form may be processed for purposes by Loughborough Schools Foundation under the Data Protection Act 2018 and that individuals have, on written request, the right of access to personal data held about them. For the purposes of compliance with the Data Protection Act 2018, I hereby give my consent to Loughborough Schools Foundation to process the personal and sensitive data supplied in the Registration Form for the purposes of administering its lists of prospective pupils.* Please tick here to show you have read and understood the above. CAPTCHA
