College

Student Details:

First Name *

Last Name *

Date of birth *

Preferred To Be Known As

Pronoun

Home Phone Number *

Mobile Number *

Student Email *

Address *

I can confirm that I/The Student can manage a 5 day timetable? (10am to 2pm) *
YesNo

If you are aged between 16 and 18 years of age, have you achieved the required grades in GCSE English and Maths? *
YesNo

Please click your 1st choice campus *
Manchester MuseumSalford Art GalleryBolton MuseumTouchstones, RochdaleHeritage Centre, MacclesfieldLeeds Art Gallery, LeedsCartwright Hall, BradfordDean Clough, HalifaxAston Hall, BirminghamBirmingham Museum and Art Gallery, BirminghamSmithfield Works, StokeMiddleport PotteryNational Museum, Cardiff

Please click your 2nd choice campus *
Manchester MuseumSalford Art GalleryBolton MuseumTouchstones, RochdaleHeritage Centre, MacclesfieldLeeds Art Gallery, LeedsLeeds Museum, LeedsCartwright Hall, BradfordDean Clough, HalifaxAston Hall, BirminghamBirmingham Museum and Art Gallery, BirminghamSmithfield Works, StokeMiddleport PotteryNational Museum, Cardiff

Proposed Start Date
—Please choose an option—Year 26/27Year 25/26

Local Authority SEND case worker

Your Local Authority

Social Worker (If you have one)

Known SEND need. Tick all that apply *
ADHDAnxietyASC/AutismCerebral PalsyDyslexiaDyspraxiaEpilepsyHearing impairmentMental health difficultiesPhysical disabilityVisual impairmentOther

Your creative interests and other things about you that you would us to know *

Does the young person have an EHCP/ Statement (Wales) *
YesNo

Does the young person have any Safeguarding incidents/issues and/or a Risk Assessment *
YesNo

How did you hear about Pinc College? *
LinkedInFacebookInstagramX.comEmailCareers AdvisorLocal AuthoritySocial WorkerHealth ProfessionalParent or Carer Group

Parents / Carers / Corporate Parent:

First Name *

Last Name *

Mobile Number *

Email *

Relationship to Student

Address (if different) *

Emergency contact details if different from above:

Name

Relationship to Student

Telephone

Emergency contact details if different from above:

Current School or College

Address

Date From / To

Most Recent Attendance (Average)*
Below 20%20% - 50%50% - 80%Above 80%

Wellbeing*
GoodSome ConcernsReq. Intervention

Overall Attainment*
ExcellingSome ConcernsNo Progress

Qualifications:

Subject 1

Grade or Expected Grade

Date (Year) Completed/Expected

Subject 2

Grade or Expected Grade

Date (Year) Completed/Expected

Subject 3

Grade or Expected Grade

Date (Year) Completed/Expected

Subject 4

Grade or Expected Grade

Date (Year) Completed/Expected

Is the young person currently in education? *
YesNo

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