Loughborough Grammar School - Sixth Form This form is for applications to Loughborough Grammar School Sixth Form. Please note, your application will be processed as soon as we receive this form and your non-refundable registration fee (See details below). 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 283727 or email grammar.admissions@lsf.orgCandidate's DetailsLegal Surname* Legal Forename(s)* Preferred Forename/Known As Date of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality* 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 Certificate No. CEFR Other School YearYear of Entry* Current Year Group Names of close relatives at, or having attended, Loughborough Schools Foundation, their relationship to candidate and school attended.Additional CommentsCurrent SchoolName of Current School* Name of Head* Address of School Street Address Address Line 2 City County / State / Region ZIP / Postal Code Email Address* Date Joined Current School*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920The Grammar School 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. Loughborough Grammar School recommends students take three subjects to A Level. In exceptional circumstances some students may take four A Level subjects, following discussion with the Head of Sixth Form or Deputy Head - (Academic). In addition, physical education and enrichment activities form part of the curriculum for all Sixth Form students. The latest Sixth Form option choices booklet (follow the link on the Sixth Form Admissions page of the www.lsf.org/grammar website) should be studied before completing this section. Please select three or four options and list them below.Proposed A Level subjects* Predicted GradesDate taken/to be takenQualification (e.g. GCSE)BoardSubjectGrade/predicted grade Personal Statement*The 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. Entrance Exam Access ArrangementsA candidate who is eligible may be given appropriate adjustment in relation to entrance examinations, 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. Please indicate here if you intend applying for a Music Scholarship. Yes School Assisted Places (SAPS)The Foundation has funds available to provide financial support towards the tuition fees for those on low incomes. Parents/Legal Guardians who indicate on this form that they wish to be considered for means tested financial support will be sent a Statement of Financial Circumstances Form which must be completed and returned together with the relevant supporting documentation by 31 October. It is not possible to consider late applicants for means tested financial support as the funds available are allocated in January. The award verification process will include a home visit.I have read and understood the above and wish to apply for a means tested Foundation School Assisted Place. Yes 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 Fee £100 per candidatePayment 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 FoundationCurrent a/c no. 08171610Sort Code 601410IBAN: GB86 NWBK 6014 1008 1716 10SWIFT CODE: NWBK GB 2LReference: GSRF and the candidate's surnameI have made payment by: Bank Transfer Cheque Credit Card Date payment was sent / madeDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920HiddenSchool email HiddenSchool telephone Data 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. Please verify