Supplementary Information Form for Year 7 entry September 2023

Supplementary Information Form for Year 7 entry September 2023
IMPORTANT: This form must be submitted to London Academy by Wednesday 30th November 2022. Please complete all sections of the form and then click the green ‘submit’ button at the end of the form.
Child's details*

First Name Last Name
Gender*

MaleFemale
Date of birth*

DayMonth Year
Date
Current Primary School:*
Parent/Guardian (with whom the child lives)*

Prefix First Name Last Name
Date of Birth*

MonthDay Year
Date
National Insurance Number*
Relationship to child*
Home Address*

Street Address

Street Address Line 2

City Borough of Residence

Postcode
Parent/Guardian (any other parent/guardian who you would like to be assessed for eligibility for free school meals)

Prefix First Name Last Name
Date of Birth

MonthDay Year
Date
National Insurance Number
Relationship to child
Is the child under the care of the Local Authority? (A Looked After Child?)*

YesNo
Has the child ever been in the care of the Local Authority or was the child adopted from care?*

YesNo
Please give details of any siblings currently attending London Academy:*
Pupil / Service Premium
1. Are you registered as eligible for free school meals or have you been so at any time over the past 6 years?*

YesNo
If you have answered yes to question 1, then you are eligible to claim preference for admission to London Academy as you qualify for the Pupil Premium. In order to claim this preference please complete the following declaration:
Child's Name:

First Name Last Name
I declare that the above named child will be eligible for the Pupil Premium in the school year beginning September 2023 and I would like to claim preference for admission to London Academy under the provision for preference for applicants qualifying for the Pupil Premium outlined the London Academy Admissions Policy.

I understand that a place can be withdrawn if fraudulent or deliberately misleading information is found to have been supplied in support of an application.
Parent/Guardian’s Name:

First Name Last Name
Parent/Guardian’s Signature

Clear
Date

DayMonth Year
Date
Parent/Guardian’s Signature*

Clear
Parent/Guardian’s Name:*

First Name Last Name
Parent/Guardian contact telephone number*
Please enter a valid phone number.
Date*

DayMonth Year
Date
Email address:*
example@example.com
Should be Empty:

Supplementary Information Form for Year 7 entry September 2023

Pupil / Service Premium