Essential Guide to the Supplementary Information Form

Supplementary Information Form

We are delighted that you are applying for a place at Christ’s Hospital.

In the following form, it is important that you give us as much information as possible. All relevant questions/sections of the form must be fully completed. If information is found to be missing or unsupported, the Admissions Team may ask for further information/documentation, to support the information given on the form.

Should you have any queries regarding your application, we would be delighted to help:

Please contact Joanne Doddington

E: jpd@christs-hospital.org.uk | T: 01403 246645

Applicant's details

Applicant’s name (as appears on their birth certificate)*

First name(s)*

Middle name(s)

Surname*

Date of birth*

Year group at entry to Christ’s Hospital*

Year of entry to Christ’s Hospital*

Parent/Guardian details

Details of adult(s) with whom the applicant currently lives.

First adult details*

First adult (mother / father / other, please specify)*

First Adult (mother / father / other, please specify)*

Please specify the relationship of the first adult to the applicant:*

Title*

First name*

Last name*

Please enter your title*

Address*

Is this your only address?*

Email address*

Home Telephone*

Work Telephone

Mobile Telephone*

Occupation**

Are there any other adults with whom the applicant currently lives with, apart from the one listed above?*

Yes

No

Second adult (mother / father / other, please specify)*

Second Adult (mother / father / other, please specify)*

Please specify the relationship of the second adult to the applicant:*

Second adult details*

Title*

First name*

Last name*

Please enter your title*

Does the second adult live at the same address as the first adult (as detailed above)?*

Yes

No

Address*

Is this your only address?*

Home Telephone*

Work Telephone

Mobile Telephone*

Occupation**

Social/Family circumstances

As a family, have you received, or are you currently receiving, support from Social Services?*

Yes

No

If you are happy to, please share details in the box below:

Special circumstances

Are there any other special circumstances you wish to draw to our attention, which are not already mentioned above?*

Yes

No

If 'YES', please give further details:*

Methods of Entry

Christ’s Hospital has some historic methods of entry. From the information given here, the Admissions Office can determine whether any of these methods of entry may be appropriate for the applicant.

Family connections

Do you have any family connections with Christ's Hospital?*

Yes

No

If 'YES', please give further details:*

HM Forces

Has either natural parent served in HM Forces?*

Yes

No

If ‘YES’ is selected, please specify below

Name:*

Name of serving parent

Rank:*

Rank of serving parent

Service dates (from)*

Date service commenced

Service dates (to)

Date service ended (if applicable)

Service Number (if known)

Service/Roll number

Branch of Service*

Has another natural parent served in HM Forces?*

Yes

No

If ‘YES’ is selected, please specify below

Name:*

Name of serving parent

Rank:*

Rank of serving parent

Service dates (from)*

Date service commenced

Service dates (to)

Date service ended (if applicable)

Service Number (if known)

Service/Roll number

Branch of Service*

Wests' Entry

Wests’ entry is for applicants who have lived for at least one year in particular parishes (which will be identified by the Admissions Office from the applicant’s address) and for an applicant who is related to John and Frances West.

Are you, to the best of your knowledge, related to the family of John or Frances West, originating in Berkshire in the 17th century?*

Yes

No

Name of relation:*

Pedigree number (if known):

Declaration*

I/We understand that:

The information given on this form is correct and complete to the best of our knowledge and belief. The School reserves the right not to proceed with an application where the information required is either not forthcoming, found to be false or is intentionally misleading.

The School reserves the right to request any document they deem necessary to support the information provided in making this application.

The application must be signed by those adults resident in the household where the applicant lives.

Each parent/legal guardian to digitally sign their name. If you are divorced or separated from the applicant’s natural parent, the Admissions Office require written permission for the application from the ex-spouse/partner in all cases of joint responsibility by provision of two signatures at the end of this application, or by a separate letter from the estranged parent.

Declaration of first parent / guardian*

Enter the full name above of the first parent / guardian, with whom the applicant resides, as your digital signature.

Date of digital signature for first parent / guardian*

Date of digital signature for first parent / guardian

Declaration of second parent / guardian

Enter the full name above of the second parent / guardian, with whom the applicant resides, as your digital signature.

Date of digital signature for second parent / guardian

Date of digital signature for second parent / guardian

Consent*

I confirm I have read the bursary and admissions policies.

Consent*

I understand that Christ’s Hospital will only use this information for the purposes of admission administration. If you would like more information about how we store and use your personal data, please see our Privacy Notice. Alternatively we can send you a copy of the Privacy Notice – please contact our Data Protection Officer, Christ’s Hospital, Horsham, West Sussex RH13 0YP

Overview

School Life

Information

Supplementary Information Form

Supplementary Information Form

Supplementary Information Form

Applicant's details

Parent/Guardian details

Dependent children in the family

Education

Health and disabilities (applicant and family)

Social/Family circumstances

Special circumstances

Methods of Entry

Family connections

HM Forces

Wests' Entry

Declaration*

Consent*

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