This form should be completed by, or with, a parent or carer if the student is currently under 16.

* 1. Student surname

* 2. First name(s)

* 3. Name known as (if different)

* 4. Legal name (if different)

* 5. Date of Birth

DD/MM/YYYY
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* 6. Gender

* 7. Contact landline number

* 8. Student mobile

* 9. Student email

* 10. Normal address (without postcode)

* 11. Postcode

* 12. If you know your address will be changing before 31 January 2017 please record the new address here and give the date you will be moving.

* 13. Surname of a parent or carer

* 14. Parent or carer's first name

* 15. Relation to the student

* 16. Has either parent been a serving member of the armed forces of the UK or its allies at any point since 2011? (Please note proof will be required if this triggers priority admission)

* 17. Parent or carer's home landline (only if different to the contact number given above)

* 18. Parent or carer's mobile number

* 19. Parent or carer's email address

* 20. Parent or carer's home address (only if this is different to the student's)

* 21. In what local authority area do you pay Council tax?

* 22. If you have it available please give your Council Tax reference number.  This will only be used if home location is applied as an over-subscription criterion.  If you don't know your Council Tax reference number this is not a problem but we may ask you to supply it at a later date.

* 23. Have you already taken any qualifications at GCSE or equivalent level? If so, please give the Awarding Body (if known), subject and grade below (you will be asked to provide copies of certificates at a later date).

* 24. Please list any subjects the student will be studying in this academic year at GCSE or equivalent level and please state the most recent predicted grade.

* 25. What sort of job would the student like to be doing in 10 years' time?

* 26. How did you first hear of South Wiltshire UTC?

* 27. Has the student received free school meals at any point since 2012? (Please note we may ask for evidence at a later date if this is used as an over-subscription criterion).

* 28. Please select the school the student currently attends from this list or add its name if it is not shown.

* 29. Does the student have any brothers or sisters already attending South Wiltshire UTC?

* 30. Does the student have a parent currently working at the UTC?

* 31. Is the student currently looked after by a local authority, or foster parents acting on behalf of a local authority, or has the student ever been looked after in this way during their secondary school career?

* 32. Please give the name of the person submitting this form:

* 33. The person named in question 32 must click each of the statements below.

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