MINISTRY OF EDUCATION
APPLICATION TO SIXTH FORM
Name
*
SURNAME
FIRST NAME
Middle Name
OTHER NAMES
SEX
*
MALE
FEMALE
DATE OF BIRTH
*
-
Year
-
Month
Day
4 digit year, 2 digit month, 2 digit day
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Email
*
example@example.com
Phone Number
*
Format: (592) 000-0000.
STATE ALL CSEC PASSES OBTAINED.
STATE ALL CSEC SUBJECTS WRITTEN IN MAY/JUNE 2020 (Please use the Plus + Icon below to add more fields for SUBJECTS [CSEC/GCE ‘O’ LEVEL] & [GRADE/YEAR] Column)
SUBJECTS (CSEC/GCE ‘O’ LEVEL)
GRADE/YEAR
QUALIFICATIONS FROM OTHER RECOGNISED INSTITUTIONS:
Rows
NAME OF INSTITUTION
QUALIFICATION (s) ACQUIRED
GRADE/LEVEL/YEAR
1.
2.
3.
Indicate subject (s) you would like to offer at CAPE.
Rows
________________________________________
________________________________________
#
#
#
What career do you have in mind? Give three (3) choices in order of preference.
Rows
________________________________________________________________________
1.
2.
3.
List the Secondary Schools you have attended so far.
*
Name the schools to which you are seeking admission in order of preference.
Rows
________________________________________________________________________
1.
2.
3.
4.
Are you prepared to accept an alternative school if so advised?
*
YES
NO
You must submit along with this Application Form:
Your Birth Certificate (or Deed Poll if relevant).
*
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A recent passport sized photograph of yourself with your name clearly written on the reverse side.
*
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A testimonial/recommendation from your present Headteacher.
*
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STUDENT’SSIGNATURE
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
GUARDIAN/PARENT’S SIGNATURE
*
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Relationship
*
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Next
Please attach your cxc results.
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Submit
FOR OFFICIAL USE ONLY
COMMENTS:
ACCEPTED
REJECTED
REFERRED
Subjects recommended:
1.________________________________ 3.______________________________ 2.________________________________ 4. ______________________________
School Recommended
__________________________________________________________________________
Should be Empty: