Initial Interest Form

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Student name:

Name of person completing this form, and relationship to student:

Year of entry you wish to apply for

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Privacy Statement

Your privacy is important to us. The information you tell us is private and stored on our student database. You can ask for a copy of the information we have about you at any time.

You can look at Key Documents to read the full statements. These policies tell you what we do with your information, how we store it, and how to ask for copies of your data.

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Section One: Your Personal Information

This information is about you, the student.

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What is your full name?

What is your date of birth?

What is your home address?

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Are you a Looked After Child, or in the care of your Local Authority?

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Section Two: Your Main Contact

This information is about the main person helping you get a place at College. This could be your parent, carer, guardian or professional. We need this information so that we talk with them about your place at College.

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What is their full name?

What is their relationship to you?

What is their home address?

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is their email address?

What is their phone number?

How would they like to be contacted?

By letter
By email
By phone

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Section Three: Your Health Conditions

This is information about you, the student. We need to know about your health conditions and disabilities so that staff can see if Homefield can help you.

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What are your disabilities or health conditions?

(For example, do you have a learning disability? Are you autistic? Do you have ADHD?)

How do your health conditions affect your learning?

(For example, do you find it hard to learn new skills or to concentrate? Do you need resources in a certain way to learn?)

How do they affect your mobility?

(For example, do you find it hard to walk? Can you use stairs? Do you use a wheelchair or crutches?)

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Section Four: Your Education

This is information about your current – or most recent – school. We need to know this information so that we can work together to support your transition to college.

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Which school do you go to?

What is their address?

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

What is their phone number?

What is the main contact's name?

(for example, a teacher, SENCO or principal)

Do you agree to Homefield College talking with your school for more information?

What are you learning at school?

(For example, are you taking any qualifications? Are you doing any work experience? What are your main learning goals?)

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Section Five: Future Goals and Interests

This is information about you, the student. This information tells us what you want to work towards in future. This helps us support you to achieve your goals.

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What are your aspirations - what would you like to achieve in life?

(For example, do you want a specific job? Do you want to volunteer? Do you want to live alone or in supported living?)

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Section Six: Extra Information

Is there any other information you would like us to know about you? Please tell us in the box below.

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What would you like Homefield to know about you?

How do you know about Homefield College?

Privacy Statement

Section One: Your Personal Information

Section Two: Your Main Contact

Section Three: Your Health Conditions

Section Four: Your Education

Section Five: Future Goals and Interests

Section Six: Extra Information

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