Sixth Form Application

For external students only - do not complete if you are currently Petchey Y11 student

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* 1. Family name:

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* 2. First name:

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* 3. Preferred first name:

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* 4. Address:

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* 5. D.O.B (dd/mm/yr)

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* 6. Gender:

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* 7. Is the student related to any previous or current Petchey Academy students?

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* 8. What is your ethnicity?

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* 9. Student Mobile Number:

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* 10. Student email address:

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* 11. 1st Language:

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* 12. 2nd Language:

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* 13. Please note, offer of a place in our Sixth Form is subject to a satisfactory reference from a member of staff at your current school who knows you well. A blank reference form can be found on the website. Alternatively, referees can email sixthform@petcheyacademy.org.uk directly.
Please give the name of your referee, the capacity in which you know them and their position. 

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