Supplementary Information Form

Language Aptitude Test
Full Name of Student*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Student's Current School*
Student's Current School Postcode*
Address*

Street Address

Street Address Line 2

CityCounty

Postal Code
Parent / Guardian Email Address*
example@example.com
Parent / Guardian Telephone
Parent / Guardian Mobile*
Does your child suffer from any medical conditions?*

YesNo
If your child suffers from any medical conditions, please provide details*
Does your child have a specific learning difficulty which may affect their performance in an aptitude test? Please note that this test will not involve any extended writing?*

YesNo
If your child has a learning difficulty which may affect performance in an aptitude test, please provide details*
Please upload a passport photo of the applying student*

Cancelof
Declaration
Full Name of Parent / Guardian *
I hereby declare that the information I have provided in this form is true and accurate to the best of my knowledge. I understand that providing false or misleading information may result in the withdrawal of any offer of a place.

GDPR Information
Stepney All Saints CofE Secondary School is compliant with the General Data Protection Regulation (GDPR) in effect from May 2018. Successful admissions: This information will be added to the pupil’s file. The retention period is calculated based on the Date of Birth of the pupil + 25 years. The forms are then securely destroyed. The file will follow the pupil if he/she transfers to another school.

Unsuccessful admissions: The retention period is until the appeals process is completed. The forms are then securely destroyed. The information will be used internally and will not be passed on to other parties unless authorised. The information submitted on this form will be automatically deleted after 1 year.
Parent/Guardian Signature*

Powered by Jotform SignClear
Print Name*
Date*

DayMonthYear
Date
Should be Empty:

Language Aptitude Test

Declaration