Admissions Loughborough Amherst School Please complete and submit the form below. Fields marked * are mandatory. If you wish to apply for more than one candidate please complete the form again. If you have any questions, please call us on +44 (0) 1509 638280 or email [email protected] Candidate's DetailsLegal Surname*Legal Forename(s)*Preferred Forename/Known AsDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Nationality*First Language*Year of Entry*Current Year Group (If applicable)*GenderBoyGirlNames of close relatives at, or having attended, Loughborough Schools Foundation, their relationship to candidate and School attended.Year Group Applying For (please tick)*Year Group:ReceptionYr1Yr2Yr3Yr4Yr5Yr6Yr7Yr8Yr9Yr10Additional CommentsCurrent School/NurseryName of current School/Nursery*Name of Head/Nursery Manager*Address of School/Nursery*Postcode*Email Address* Date joined current School/Nursery*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Parent/Legal Guardian DetailsParent Legal/Guardian 1Title*Forename(s)*Surname*Relationship to candidate*Address* Street Address Address Line 2 City County Postcode Home Phone*Mobile PhoneEmail Address* Occupation*Employer*Add additional parent/legal guardian? Yes Parent Legal/Guardian 2Title*Forename(s)*Surname*Relationship to candidate*Is your address the same as above? Yes Address* Street Address Address Line 2 City County Postcode Home Phone*Mobile PhoneEmail Address* Occupation*Employer*Where parents have separated or divorced, please state with which parent the candidate resides.Entrance Assessment Access ArrangementsA candidate who is eligible may be given an appropriate adjustment in relation to entrance assessments, subject to documentary evidence being provided. If the candidate has had a specialist assessment diagnosing a learning difficulty or disability, for example an educational psychologist’s report, medical report, occupational therapist’s report, please give brief details on a separate sheet and attach a copy of the most recent report. If the candidate suffers from any medical condition or physical incapacity of which we should be aware, please give details on a separate sheet and attach a copy of the most recent report.Please indicate here if you wish to discuss further. Yes If you wish to attach any documentation you may do so here. Drop files here or Accepted file types: jpg, png, doc, docx. If the candidate has had a specialist assessment diagnosing a learning difficulty or disability, for example an educational psychologist's report, medical report, occupational therapist's report, please give brief details on a separate sheet and attach a copy of the most recent report. If the candidate suffers from any medical or physical incapacity of which we should be aware, please give details below.Medical or physical conditionScholarshipsApplications for Music Scholarships should be made directly to the Music department. Further details, including the deadline for applications, are available on www.lsf.org/music and www.lsf.org/amherst. Music Scholarship auditions are held around the time of the academic entrance examination. Please indicate here if you intend applying for a Music Scholarship. Yes School Assisted Places (SAPS) and Assisted ScholarshipsThe Foundation has funds available to provide financial support towards the tuition fees for those on low incomes. We offer a small number of Assisted Scholarship places to pupils joining us in Years 7, 8, 9 and 10. Scholarship offers are based on the combined information gathered from assessment scores, family income and a formal interview with the pupil. Parents/Legal Guardians who indicate on this form that they wish to be considered for means tested financial support will be sent a Statement of Financial Circumstances Form which must be completed and returned together with the relevant supporting documentation by the end of December preceding the entrance assessment. It is not possible to consider late applicants for means tested financial support as the funds available are allocated in January. The award verification process will include a home visit.I have read and understood the above and wish to apply for a means tested Foundation School Assisted Place. Yes I have read and understood the above and wish to apply for a means tested Assisted Scholarship. Yes Further DetailsPlease use this space to provide any further details relative to any matter about which you feel we should be aware.Data ProtectionI understand that information from this form may be processed for purposes by Loughborough Schools Foundation under the Data Protection Act 2018 and that individuals have, on written request, the right of access to personal data held about them. For the purposes of compliance with the Data Protection Act 2018, I hereby give my consent to Loughborough Schools Foundation to process the personal and sensitive data supplied in the Registration Form for the purposes of administering its lists of prospective pupils.* Please tick here to show you have read and understood the above. Registration Fee£50 for entry to Reception up to Year 6 £100 for entry in to Year 7 or above. Payment can be made either by bank transfer using the following details or by cheque (payable to Loughborough Schools Foundation): Loughborough Schools FoundationCurrent a/c no. 08171610 Sort Code 601410Reference: ASRF and candidate's surnameBank Transfer I have paid by bank transfer Date payment was madeDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Cheque I have paid by cheque Date cheque was sent or delivered to schoolDay12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920School emailSchool telephoneNameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.